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VAERS ID: 1668800

AGE: 15| SEX: M|State: FR

Description

Death/passed away; This is a spontaneous report from a contactable consumer or other non HCP (parent, father of patient). A 15-year-old male patient received the first dose of bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE), via an unspecified route of administration in the left arm on 09Aug2021 at 09:00 AM (at the age of 15-year-old; lot number: FF2154) as DOSE 1, SINGLE for COVID-19 immunisation. The patient's medical history and concomitant medications were not provided. The patient did not receive any other vaccines within 4 weeks prior to the COVID vaccine. The father reported that the patient (the son) received the dose 1 of the Pfizer vaccine on 09Aug2021 at 9AM on left arm. Unfortunately, patient passed away (death) on Friday 13Aug2021 at 04:30 without any history of illness. The event resulted in Emergency room/department or urgent care. Prior to vaccination, patient did not diagnose with COVID-19. Since the vaccination, patient did not test for COVID-19. Device date was 29Aug2021. No treatment received. Outcome of the event was fatal. It was not reported if an autopsy was performed.; Reported Cause(s) of Death: Death/passed away

Symptoms

Death

Vaccines

VAX DATE: 08 August 2021 | ONSET DATE: 12 August 2021 | DAYS TO ONSET: 4
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • 1
  • LA
  • FF2154

RECVDATE:02 September 2021
CAGE_YR:
CAGE_MO:
RPT_DATE:
DIED:Y
DATEDIED:12 August 2021
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:N
LAB_DATA:
V_ADMINBY:OTH
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:JOPFIZER INC202101119141
FORM_VERS:2
TODAYS_DATE:31 August 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:Y
ALLERGIES:
V_FUNDBY:
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