VAERS ID: 1242573

AGE: 15| SEX: M|State: CO

Description

Heart failure

Symptoms

Cardiac failure, Death

Vaccines

VAX DATE: 17 April 2021 | ONSET DATE: 18 April 2021 | DAYS TO ONSET: 1
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))

        RECVDATE:
        21 April 2021
        CAGE_YR:
        15
        CAGE_MO:
        RPT_DATE:
        DIED:
        Y
        DATEDIED:
        19 April 2021
        L_THREAT:
        ER_VISIT:
        HOSPITAL:
        HOSPDAYS:
        X_STAY:
        DISABLE:
        RECOVD:
        N
        LAB_DATA:
        V_ADMINBY:
        PUB
        OTHER_MEDS:
        Vaccinated with Pfizer/Biontech, died 04/20/2021, 2 days after vaccination
        CUR_ILL:
        No
        HISTORY:
        No
        PRIOR_VAX:
        SPLTTYPE:
        FORM_VERS:
        2
        TODAYS_DATE:
        21 April 2021
        BIRTH_DEFECT:
        OFC_VISIT:
        Y
        ER_ED_VISIT:
        ALLERGIES:
        Nothing
        V_FUNDBY: