VAERS ID: 2275432

AGE: 68| SEX: F|STATE: MD (United States)

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.

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Symptoms

Drug ineffective, COVID-19

Vaccines

VAX DATE: 10-01-2021| ONSET DATE: | DAYS TO ONSET:
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 3 COVID19 PFIZER\BIONTECH 301308a LA

RECVDATE:05-13-2022
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:
V_ADMINBY:
OTHER_MEDS:FAMOTIDINE
CUR_ILL:
HISTORY:Medical History/Concurrent Conditions: GERD; Sulfonamide allergy (sulfa drugs allergy)
PRIOR_VAX:
SPLTTYPE:USPFIZER INC202200696592
FORM_VERS:
TODAYS_DATE:05-12-2022
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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