VAERS ID: 2275436

AGE: 74| SEX: M|STATE: MD (United States)

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.

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Symptoms

Drug ineffective, Suspected COVID-19

Vaccines

VAX DATE: 03-31-2022| ONSET DATE: | DAYS TO ONSET:
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 4 COVID19 PFIZER\BIONTECH FK9895 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:
CUR_ILL:
HISTORY:Medical History/Concurrent Conditions: Emphysema (Mastocytosis emphysema); Mastocytosis (Mastocytosis emphysema)
PRIOR_VAX:
SPLTTYPE:USPFIZER INC202200696695
FORM_VERS:
TODAYS_DATE:05-12-2022
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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