VAERS ID: 1382906
AGE: 15|
SEX:
M|State:
CA
Description
Unexplained death within 48 hours
Symptoms
Death
Vaccines
VAX DATE: 14 May 2021 |
ONSET DATE: 06 June 2021 |
DAYS TO ONSET: 23
| Vaccine Type | Manufacturer | Vaccine Name | Dose | Route | Site | Lot |
|---|
|
|
- COVID19 (COVID19 (PFIZER-BIONTECH))
|
|
|
|
|
- RECVDATE:
- 07 June 2021
- CAGE_YR:
- 15
- CAGE_MO:
- RPT_DATE:
- DIED:
- Y
- DATEDIED:
- 06 June 2021
- L_THREAT:
- ER_VISIT:
- HOSPITAL:
- HOSPDAYS:
- X_STAY:
- DISABLE:
- RECOVD:
- N
- LAB_DATA:
- V_ADMINBY:
- OTH
- OTHER_MEDS:
- None known
- CUR_ILL:
- none noted
- HISTORY:
- Acne, no other conditions noted
- PRIOR_VAX:
- SPLTTYPE:
- FORM_VERS:
- 2
- TODAYS_DATE:
- 07 June 2021
- BIRTH_DEFECT:
- OFC_VISIT:
- ER_ED_VISIT:
- ALLERGIES:
- None noted
- V_FUNDBY: