| VAERS ID: |
1633205 (history) |
| Form: |
Version 2.0 |
| Age: |
13.0 |
| Sex: |
Male |
| Location: |
Foreign |
| Vaccinated: |
2021-08-11 |
| Onset: |
2021-08-13 |
| Days after vaccination: |
2 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-08-25 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
10020A / 2 |
- / - |
Administered by: Other Purchased by: ?
Symptoms: Activated partial thromboplastin time, Disseminated intravascular coagulation, International normalised ratio, Multiple organ dysfunction syndrome, N-terminal prohormone brain natriuretic peptide, Platelet count, Prothrombin time, Pulmonary haemorrhage, Pyrexia, Septic shock, Troponin T
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Sepsis (narrow), Opportunistic infections (broad) Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 2021-08-14
Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: Write-up: |
