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VAERS ID: 1995609

AGE: 13| SEX: M|State: NY

Description

Breakthrough COVID Case; Breakthrough COVID Case; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. An adolescent male patient received bnt162b2 (BNT162B2), administration date May2021 (Batch/Lot number: unknown) at the age of 13 years as dose 2, single for covid-19 immunisation. The patient's relevant medical history and concomitant medications were not reported. Vaccination history included: Bnt162b2 (prev dose product=COVID 19, prev dose brand=Pfizer Covid Vaccine, prev dose brand unknown=False, prev dose lot unknown=True, prev dose lot unknown reason=Not, available/provided to reporter at the time of report completion, prev dose administration date=May2021, prev dose dose number=1), administration date: May2021, for COVID-19 immunisation. The following information was reported: DRUG INEFFECTIVE (medically significant), COVID-19 (medically significant) all with onset 21Dec2021, outcome "unknown" and all described as "Breakthrough COVID Case". The patient underwent the following laboratory tests and procedures: sars-cov-2 test: (21Dec2021) positive, notes: Unknown. Therapeutic measures were not taken as a result of drug ineffective, covid-19. Additional information: It was unknown if the patient received any other vaccine in four weeks. Prior to vaccination, patient did not suffer from COVID. Patient was tested for COVID post vaccination. The lot number for bnt162b2 was not provided and will be requested during follow up.

Symptoms

COVID-19, Drug ineffective, SARS-CoV-2 test

Vaccines

VAX DATE: 30 April 2021 | ONSET DATE: 20 December 2021 | DAYS TO ONSET: 234
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • 2

RECVDATE:
30 December 2021
CAGE_YR:
CAGE_MO:
RPT_DATE:
DIED:
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:
U
LAB_DATA:
Test Date: 20211221; Test Name: Home Test; Result Unstructured Data: Test Result:Positive; Comments: Unknown
V_ADMINBY:
UNK
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
USPFIZER INC202101844321
FORM_VERS:
2
TODAYS_DATE:
29 December 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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