VAERS ID: |
1854668 (history) |
Form: |
Version 2.0 |
Age: |
16.0 |
Sex: |
Female |
Location: |
Wisconsin |
Vaccinated: |
2021-09-07 |
Onset: |
2021-09-01 |
Submitted: |
0000-00-00 |
Entered: |
2021-11-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
301308A / 2 |
LA / SYR |
Administered by: Private Purchased by: ? Symptoms: Death, Fatigue, Myalgia, Thrombosis SMQs:, Rhabdomyolysis/myopathy (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad) Life Threatening? No Birth Defect? No Died? Yes
Date died: 2021-09-10
Days after onset: 9 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: omeprazole gabapentin celecoxib nivolumab was last given on 9/03/2021 Current Illness: Squamous cell lung cancer, Hx of radiation therapy, on antineoplastic chemotherapy, Esophagitis due to radiation, Preexisting Conditions: Recurrent respiratory papillomatosis, Tracheal papillomatosis Allergies: Pineapple Diagnostic Lab Data: There was no autopsy ordered CDC Split Type: Write-up: Was very tired and had sore muscles on September 09. Found September 10, 5:25 am dead. There were excessive amounts of blood along with large blood clots that appear to have come vaginally. |