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VAERS ID: 2275432

AGE: 68| SEX: F|State: MD

Description

Covid-19; Covid-19; This is a spontaneous report received from contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 69-year-old female patient (not pregnant) received BNT162b2 (BNT162B2), on 30Jan2021 as dose 1, single (Lot number: EN5328), in left arm, on 02Feb2021 as dose 2, single (Lot number: EL9264), in left arm and on 01Oct2021 as dose 3 (booster), single (Lot number: 301308A) at the age of 68 years, in left arm for covid-19 immunisation. The patient's relevant medical history included: "GERD" (unspecified if ongoing); "Known allergy sulfa drug" (unspecified if ongoing), notes: sulfa drugs allergy. Concomitant medication(s) included: FAMOTIDINE, start date: 08Jan2021. The following information was reported: DRUG INEFFECTIVE (medically significant), COVID-19 (medically significant), outcome "unknown" and all described as "Covid-19". Therapeutic measures were taken as a result of drug ineffective, covid-19.

Symptoms

COVID-19, Drug ineffective

Vaccines

VAX DATE: 30 September 2021 | ONSET DATE: | DAYS TO ONSET:
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • 3
  • LA
  • 301308A

RECVDATE:12 May 2022
CAGE_YR:
CAGE_MO:
RPT_DATE:
DIED:
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:U
LAB_DATA:
V_ADMINBY:UNK
OTHER_MEDS:FAMOTIDINE
CUR_ILL:
HISTORY:Medical History/Concurrent Conditions: GERD; Sulfonamide allergy (sulfa drugs allergy)
PRIOR_VAX:
SPLTTYPE:USPFIZER INC202200696592
FORM_VERS:2
TODAYS_DATE:11 May 2022
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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