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VAERS ID: 2275436

AGE: 74| SEX: M|State: MD

Description

Suspected COVID-19; SUSPECTED COVID-19; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. A 75-year-old male patient received BNT162b2 (BNT162B2), on 25Jan2021 as dose 1, single (Lot number: el9262), in left arm, on 25Feb2021 as dose 2, single (Lot number: el9266), in left arm, on 26Aug2021 as dose 3 (booster), single (Lot number: fc3181), in left arm and on 31Mar2022 at 11:30 as dose 4 (booster), single (Lot number: fk9895) at the age of 74 years, in left arm for covid-19 immunisation. The patient's relevant medical history included: "Mastocytosis emphysema" (unspecified if ongoing), notes: Mastocytosis emphysema; "Mastocytosis emphysema" (unspecified if ongoing), notes: Mastocytosis emphysema. The patient's concomitant medications were not reported. The following information was reported: SUSPECTED COVID-19 (medically significant) with onset 2022, outcome "unknown"; DRUG INEFFECTIVE (medically significant) with onset 2022, outcome "unknown", described as "Suspected COVID-19". Therapeutic measures were taken as a result of drug ineffective, suspected covid-19. No follow-up attempts are possible. No further information is expected.

Symptoms

Drug ineffective, Suspected COVID-19

Vaccines

VAX DATE: 30 March 2022 | ONSET DATE: | DAYS TO ONSET:
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • 4
  • LA
  • fk9895

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:Medical History/Concurrent Conditions: Emphysema (Mastocytosis emphysema); Mastocytosis (Mastocytosis emphysema)
PRIOR_VAX:
SPLTTYPE:USPFIZER INC202200696695
FORM_VERS:2
TODAYS_DATE:11 May 2022
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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