Adverse Event Reporting
| VAERS ID | 2040397 |
|---|---|
| Gender | Female |
| Age | |
| StateCode | FR |
| Pharmaceutical Company | PFIZER\BIONTECH |
| Lot Number | FD0168 |
| Number of vaccinations | 2 |
| Vaccinated | 2021-06-15 |
| Onset | 2021-11-30 |
| Condition | Died |
Symptoms
- SARS-CoV-2 test
- COVID-19
- Drug ineffective
Current Illness
Preexisting Conditions
Other Medications
Previous Vaccinations
Allergies
Laboratory Data
Test Date: 20211130; Test Name: COVID-19 PCR test; Test Result: Positive ; Comments: Variante PCR based: No Information.
Variante sequenced: No Information.
n501y-positive: Unknown
Write-up
SARS-CoV-2 infection; drug ineffective; This is a spontaneous report received from a contactable reporter(s) (Physician) from a regulatory authority.
Regulatory number: AT-BASGAGES-2021-075724.
A 85 year-old female patient received bnt162b2 (COMIRNATY), intramuscular, administration date 15Jun2021 (Lot number: FD0168) as dose 2, single and intramuscular, administration date 04May2021 (Lot number: EY3014) as dose 1, single for covid-19 immunisation.
The patient's relevant medical history and concomitant medications were not reported.
The following information was reported: COVID-19 (death) with onset 30Nov2021, outcome "fatal", described as "SARS-CoV-2 infection"; DRUG INEFFECTIVE (death) with onset 30Nov2021, outcome "fatal", described as "drug ineffective".
The patient underwent the following laboratory tests and procedures: sars-cov-2 test: (30Nov2021) positive, notes: Variante PCR based: No Information.
Variante sequenced: No Information.
n501y-positive: Unknown.
The patient date of death was unknown.
The reported cause of death was covid-19.
It was not reported if an autopsy was performed.
No follow-up attempts are possible.
No further information is expected.
; Sender's Comments: Linked Report(s) : AT-PFIZER INC-202200050900 same patient, same medication, different doses, different events; Reported Cause(s) of Death: SARS-CoV-2 infection