| 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: |
