VAERS ID: |
1865979 (history) |
Form: |
Version 2.0 |
Age: |
12.0 |
Sex: |
Male |
Location: |
Foreign |
Vaccinated: |
2021-10-13 |
Onset: |
2021-10-14 |
Days after vaccination: |
1 |
Submitted: |
0000-00-00 |
Entered: |
2021-11-12 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
SDCN1 / 2 |
- / - |
Administered by: Other Purchased by: ? Symptoms: Death, Decreased appetite, Headache, Myocarditis, Pyrexia SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), Noninfectious myocarditis/pericarditis (narrow) Life Threatening? Yes Birth Defect? No Died? Yes
Date died: 2021-10-15
Days after onset: 1 Permanent Disability? No Recovered? No Office Visit? No ER Visit? No ER or Doctor Visit? No Hospitalized? No Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type: Write-up: |