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))

        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: