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VAERS ID: 2275434

AGE: 66| SEX: M|State: NJ

Description

COVID-19; COVID-19; vaccine location=Left leg; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 67-year-old male patient received BNT162b2 (BNT162B2), on 06Oct2021 as dose 3 (booster), single (Lot number: ff2589) at the age of 66 years, in left leg for covid-19 immunisation; coviD-19 vaccine (COVID-19 VACCINE), as dose 1, single (Batch/Lot number: unknown) and as dose 2, single (Batch/Lot number: unknown) for covid-19 immunization. The patient had no relevant medical history. There were no concomitant medications. The following information was reported: PRODUCT ADMINISTERED AT INAPPROPRIATE SITE (non-serious) with onset 06Oct2021, outcome "unknown", described as "vaccine location=Left leg"; DRUG INEFFECTIVE (medically significant), COVID-19 (medically significant) all with onset Apr2022, outcome "unknown" and all described as "COVID-19". Therapeutic measures were taken as a result of drug ineffective, covid-19 included Paxlovid.

Symptoms

COVID-19, Drug ineffective, Product administered at inappropriate site

Vaccines

VAX DATE: 05 October 2021 | ONSET DATE: 05 October 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • UNKNOWN MANUFACTURER
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • COVID19 (COVID19 (UNKNOWN))
  • 2
  • 3
  • ff2589

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:
CUR_ILL:
HISTORY:Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: NONE, Comment: Other medical history: None known allergies: no
PRIOR_VAX:
SPLTTYPE:USPFIZER INC202200696645
FORM_VERS:2
TODAYS_DATE:11 May 2022
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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