VAERS ID: 1689212

AGE: 17| SEX: M|State: TX

Description

SARS COV2 POSITIVE ON 7/20; EXPIRED 8/29/2021

Symptoms

COVID-19, Death, SARS-CoV-2 test positive

Vaccines

VAX DATE: 16 April 2021 | ONSET DATE: 19 July 2021 | DAYS TO ONSET: 94
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))

        RECVDATE:
        09 September 2021
        CAGE_YR:
        17
        CAGE_MO:
        RPT_DATE:
        DIED:
        Y
        DATEDIED:
        28 August 2021
        L_THREAT:
        ER_VISIT:
        HOSPITAL:
        Y
        HOSPDAYS:
        51
        X_STAY:
        DISABLE:
        RECOVD:
        N
        LAB_DATA:
        V_ADMINBY:
        PVT
        OTHER_MEDS:
        CETIRIZINE, ERGOCALCIFEROL,
        CUR_ILL:
        STAGE IV TESTICULAR EMBRYONAL RHABDOMYOSARCOMA W/ LUNG & BONE METASTASES
        HISTORY:
        SEE ABOVE
        PRIOR_VAX:
        SPLTTYPE:
        FORM_VERS:
        2
        TODAYS_DATE:
        09 September 2021
        BIRTH_DEFECT:
        OFC_VISIT:
        ER_ED_VISIT:
        ALLERGIES:
        VANCOMYCIN, TEMSIROLIMUS
        V_FUNDBY: