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VAERS ID: 2275435

AGE: 61| SEX: M|State: IL

Description

Covid-19; Covid-19; Dose Number 4: 07Dec2021; Dose Number 4: 07Dec2021; Dose Number 4: 07Dec2021; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 62-year-old male patient received BNT162b2 (BNT162B2), on 07Dec2021 as dose 4 (booster), single (Batch/Lot number: unknown) at the age of 61 years for covid-19 immunisation; coviD-19 vaccine (COVID-19 VACCINE), as dose 1, single (Batch/Lot number: unknown), as dose 2, single (Batch/Lot number: unknown) and as dose 3 (booster), single (Batch/Lot number: unknown) for covid-19 immunisation. The patient's relevant medical history was not reported. There were no concomitant medications. The following information was reported: IMMUNISATION (medically significant), OFF LABEL USE (medically significant), INAPPROPRIATE SCHEDULE OF PRODUCT ADMINISTRATION (non-serious) all with onset 07Dec2021, outcome "unknown" and all described as "Dose Number 4: 07Dec2021"; COVID-19 (medically significant), DRUG INEFFECTIVE (medically significant) all with onset 03May2022, outcome "unknown" and all described as "Covid-19". The patient underwent the following laboratory tests and procedures: SARS-CoV-2 test: (28Apr2022) Negative, notes: Tested negative on 28Apr to 01May; (03May2022) Positive; (08May2022) Negative. Therapeutic measures were taken as a result of covid-19, drug ineffective. The information on the batch/lot number for BNT162b2 has been requested and will be submitted if and when received.

Symptoms

COVID-19, SARS-CoV-2 test, Drug ineffective, Immunisation, Inappropriate schedule of product administration, Off label use

Vaccines

VAX DATE: 06 December 2021 | ONSET DATE: 06 December 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • UNKNOWN MANUFACTURER
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • COVID19 (COVID19 (UNKNOWN))
  • 3
  • 4

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:Test Date: 20220428; Test Name: COVID-19 Test; Test Result: Negative ; Comments: Tested negative on 28Apr to 01May; Test Date: 20220503; Test Name: COVID-19 Test; Test Result: Positive ; Test Date: 20220508; Test Name: COVID-19 Test; Test Result: Negative
V_ADMINBY:UNK
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:USPFIZER INC202200696685
FORM_VERS:2
TODAYS_DATE:11 May 2022
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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