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VAERS ID: 2275438

AGE: 65| SEX: F|State: MI

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 65-year-old female patient (not pregnant) received BNT162b2 (BNT162B2), on 08Sep2021 as dose 1, single (Lot number: FE3592), in left arm and on 08Oct2021 at 13:15 as dose 2, single (Lot number: FF8839) at the age of 65 years, in left arm for covid-19 immunisation. The patient's relevant medical history included: "esophageal ca" (unspecified if ongoing), notes: other medical history: esophageal ca; "Penicillin allergy" (unspecified if ongoing). Concomitant medication(s) included: LEVOTHYROXINE, start date: 25Apr2022, stop date: 09May2022; DEXAMETHASONE, start date: 05May2022, stop date: 06May2022; OMEPRAZOLE, start date: 25Apr2022, stop date: 09May2022; FERROUS [IRON], start date: 25Apr2022, stop date: 09May2022; ZINC [ZINC SULFATE], start date: 25Apr2022, stop date: 09May2022; VITAMIN B-12, start date: 25Apr2022, stop date: 09May2022; KEYTRUDA, start date: 04May2022, stop date: 04May2022; ALOXI, start date: 04May2022, stop date: 04May2022; LEUCOVORIN [FOLINIC ACID], start date: 04May2022, stop date: 04May2022; OXALIPLATIN, start date: 04May2022, stop date: 04May2022; ADRUCIL, start date: 04May2022, stop date: 06May2022. The following information was reported: DRUG INEFFECTIVE (medically significant), COVID-19 (medically significant) all with onset 2022, outcome "unknown" and all described as "COVID-19". Therapeutic measures were taken as a result of drug ineffective, covid-19. Clinical course: Seriousness criteria-Results in death was reported as no. Seriousness criteria-Life threatening was reported as no. Seriousness criteria-Caused/prolonged hospitalization was reported as no. Seriousness criteria-Disabling/Incapacitating was reported as no. Seriousness criteria-Congenital anomaly/birth defect was reported as no. Were you/Was the patient taking any other medications/products within 2 weeks of starting COVID-19 treatment was reported as yes. Did you/the patient previously receive a COVID-19 Vaccine was reported as yes.

Symptoms

COVID-19, Drug ineffective

Vaccines

VAX DATE: 07 October 2021 | ONSET DATE: | DAYS TO ONSET:
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • 2
  • LA
  • FF8839

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:LEVOTHYROXINE; DEXAMETHASONE; OMEPRAZOLE; FERROUS [IRON]; ZINC [ZINC SULFATE]; VITAMIN B-12; KEYTRUDA; ALOXI; LEUCOVORIN [FOLINIC ACID]; OXALIPLATIN; ADRUCIL
CUR_ILL:
HISTORY:Medical History/Concurrent Conditions: Esophageal cancer (other medical history: esophageal ca); Penicillin allergy
PRIOR_VAX:
SPLTTYPE:USPFIZER INC202200696729
FORM_VERS:2
TODAYS_DATE:11 May 2022
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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