VAERS ID: |
1784945 (history) |
Form: |
Version 2.0 |
Age: |
12.0 |
Sex: |
Female |
Location: |
South Carolina |
Vaccinated: | 2021-07-11 |
Onset: | 2021-08-02 |
Days after vaccination: | 22 |
Submitted: |
0000-00-00 |
Entered: |
2021-10-14 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EW0179 / 1 |
UN / SYR |
Administered by: Private Purchased by: ? Symptoms: Death,
Respiratory tract haemorrhage SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-08-02
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Trisomy 18, Scoliosis, Closed Ventricular Septal Defect, Ectopic Kidney, Gastrostomy Tube dependent, GERD, and Obstructive Sleep Apnea Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Blood in airway, Death |