VAERS ID: 2315236

AGE: 54| SEX: F|STATE:

Description

COVID; COVID; This is a solicited report received from contactable reporter(s) (Consumer or other non HCP). The reporter is the patient. Other Case identifier(s): 22K-163-4420040-00. A 54-year-old female patient received BNT162b2 (BNT162B2), on 13Mar2021 as dose 1, single (Batch/Lot number: unknown), on 03Apr2021 as dose 2, single (Batch/Lot number: unknown) and on 07Oct2021 as dose 3 (booster), single (Batch/Lot number: unknown) at the age of 54 years, all intramuscular for covid-19 immunisation; adalimumab (HUMIRA), (Lot number: 1159928), subcutaneous for rheumatoid arthritis. The patient's relevant medical history was not reported. Concomitant medication(s) included: TRULICITY, start date: May2022. The following information was reported: VACCINATION FAILURE (medically significant) with onset 26May2022, outcome "unknown", COVID-19 (medically significant) with onset 26May2022, outcome "recovering" and all described as "COVID". The reporter considered "covid" related to BNT162b2. The information on the batch/lot number for BNT162b2 has been requested and will be submitted if and when received.; Sender's Comments: Based on the available information in the case, the causal association between the events Vaccination failure, COVID and the suspect drug BNT162B2 cannot be excluded.

Symptoms

COVID-19, Vaccination failure

Vaccines

VAX DATE: 10-07-2021| ONSET DATE: 05-26-2022| DAYS TO ONSET: 231
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 3 COVID19 PFIZER\BIONTECH OT Unknown
VACCINE NOT SPECIFIED (NO BRAND NAME) Unknown UNK Unknown 1159928 OT Unknown

RECVDATE:06-10-2022
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:
OTHER_MEDS:TRULICITY; HUMIRA
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:USPFIZER INC202200805820
FORM_VERS:2
TODAYS_DATE:06-08-2022
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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