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The specific subclass of the IgG response also correlates with severity, with the potent immune-activating IgG1 and IgG3 (and particularly the combination of the two) being the most common in severe cases [181,182,183]

Google Scholar Van der Knaap JA, Kumar BR, Moshkin YM

Yudushkin I

And the breakthrough cases we see are by and large in the extremely elderly or people who are severely immunocompromised and were not able to achieve adequate protection from their first vaccine doses

Supporting Clinical Information: Include any additional documentation that supports the necessity and appropriateness of the injection, such as relevant lab results, prior evaluation notes, or referral letters