kidney transplant recipients who developed COVID-19 more than 14 days after receipt of 2 doses of SARSCoV- 2 mRNA vaccine, administered at the recommended dosing interval; kidney transplant recipients who developed COVID-19 more than 14 days after receipt of 2 doses of SARSCoV- 2 mRNA vaccine, administered at the recommended dosing interval; This is a literature report. This author reported similar events in four patients. This is forth of four reports  Recently, a study showed that only 54% of organ transplant recipients developed a positive antibody response after 2 doses of SARS-CoV-2 mRNA vaccine and, among kidney transplant recipients, only 48% had an antibody response 4. At our center the seropositivity rate in organ transplant recipients was 37.2% 5.This suggests that a significant proportion of transplant recipients remain at risk for COVID-19 despite completing the vaccination series. Our center encourages COVID-19 vaccination for all transplant recipients. We estimate an active follow-up of approximately 1,680 fully vaccinated kidney transplant recipients. We had 8 kidney transplant recipients who developed COVID-19 more than 14 days after receipt of 2 doses of SARSCoV- 2 mRNA vaccine, administered at the recommended dosing interval (table). All patients were symptomatic, most commonly with fatigue and cough. The median age was 65 years old (range 36-73), 50% had received a previous transplant, the median time from the most recent transplant to the first dose of mRNA vaccine was 31 months (range 3 - 248), and 3 out of 8 patients had received thymoglobulin for induction in the 6 months preceding vaccination. All patients were on calcineurin inhibitor (CNI)-based immunosuppression and 7 of the 8 were on mycophenolate mofetil. CNI level goals were not changed during illness, anti-metabolite doses were reduced or held based on symptoms and severity, at the discretion of the nephrologist. Symptom onset and SARS-CoV-2 testing occurred at a median of 56 days (range 18-77) and 59 days (range 20-77) after the second dose of the vaccine, respectively. Three patients received casirivimab/imdevimab as outpatient and did not require hospital admission. Three patients were hospitalized and had a length of stay of 3 to 5 days, without requiring ICU admission or mechanical ventilation. All were discharged to home without oxygen. None of the patients had anti-SARS-CoV-2 spike protein antibody checked after vaccination or disease and viruses were not sequenced. Data on the COVID-19 vaccine effectiveness is emerging, however, vaccine effectiveness in the immunocompromised population is lacking. It is encouraging that our breakthrough cases of COVID-19 after vaccination were mild and associated with good outcomes. However, we should continue to encourage our patients to be vaccinated and also encourage vaccination of household members and close contacts. Recent guidance allowing fully vaccinated individuals to resume prepandemic activities probably should not apply to transplant recipients.  A 57-years-old male patient received bnt162b2 (PFIZER-BIONTECH COVID-19 MRNA VACCINE), via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as Dose 1, single and via an unspecified route of administration on an unspecified date (Batch/Lot number was not reported) as Dose 2, single, both for covid-19 immunisation.  Medical history included renal transplant from an unknown date (Time from transplant to 1st vaccine dose was 151 months).  The patient's concomitant medications were not reported. Ongoing concomitant drug included Tacrolimus, MMF(mycophenolate mofetil) and prednisone. The patient was kidney transplant recipients who developed covid-19 more than 14 days after receipt of 2 doses of sarscov- 2 mrna vaccine, administered at the recommended dosing interval on an unspecified date. The symptoms of covid-19 included Cough, congestion and fever was occurred 60 days after the second dose.  The events of covid-19 was without requiring hospitalization, ICU, Mechanical ventilation and O2 supplement. The patient underwent lab tests and procedures which included sars-cov-2 test: positive 62 days after the second dose.  The outcome of covid-19 was unknown after 3 days home stay. Patient was alive on the latest follow up.  No follow-up attempts are possible. No further information is expected.; Sender's Comments: Based on the information currently available, a lack of efficacy with bnt162b2 towards the breakthrough COVID-19 infection following vaccination in this patient cannot be completely excluded.,Linked Report(s) : US-PFIZER INC-202101115297 Same article/ drug/event and different patient: