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VAERS ID: 1784945

AGE: 12| SEX: F|State: SC

Description

Blood in airway, Death

Symptoms

Death, Respiratory tract haemorrhage

Vaccines

VAX DATE: 10 July 2021 | ONSET DATE: 01 August 2021 | DAYS TO ONSET: 22
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • 1
  • SYR
  • UN
  • EW0179

RECVDATE:13 October 2021
CAGE_YR:12
CAGE_MO:
RPT_DATE:
DIED:Y
DATEDIED:01 August 2021
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:N
LAB_DATA:
V_ADMINBY:PVT
OTHER_MEDS:
CUR_ILL:
HISTORY:Trisomy 18, Scoliosis, Closed Ventricular Septal Defect, Ectopic Kidney, Gastrostomy Tube dependent, GERD, and Obstructive Sleep Apnea
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:13 October 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:Y
ALLERGIES:
V_FUNDBY:
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