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VAERS ID: 1865979

AGE: 12| SEX: M|State: FR

Description

Found dead; Myocarditis; Headache; Fever; Appetite lost; This is a spontaneous report from a non-contactable physician downloaded from the Regulatory Agency (A)-WEB, regulatory authority number DE-PEI-202100217297. A 12-year-old Male patient received the second dose of Bnt162b2 (COMIRNATY) on 13Oct2021 at the age of 12-year-old (Lot/Batch: SDCN1) as 0.3 ml single dose for covid-19 immunisation. The patient's medical history included Distal arthrogryposis, Cardiomyopathy. Concomitant medications were not reported. The patient previously received the first dose of bnt162b2 (COMIRNATY) on 22Sep2021 at the age of 12-year-old as 0.3 ml single dose for covid-19 vaccination/immunisation. On 14Oct2021 the patient experienced Fever, Headache, Appetite lost. On 15Oct2021 the patient experienced Found dead, Myocarditis. This report is serious due to death, life threatening. Relatedness of drug to reaction(s)/event(s): Source of assessment: Agency. Result of Assessment: D. Unclassifiable. Autopsy Done and Results was Available as Cardiac death in cardiomyopathy. The outcome of the event was fatal. No follow-up attempts are possible, no further inforamtion is expected.; Autopsy-determined Cause(s) of Death: Cardiac death in cardiomyopathy

Symptoms

Death, Decreased appetite, Headache, Myocarditis, Pyrexia

Vaccines

VAX DATE: 12 October 2021 | ONSET DATE: 13 October 2021 | DAYS TO ONSET: 1
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • 2
  • SDCN1

RECVDATE:11 November 2021
CAGE_YR:
CAGE_MO:
RPT_DATE:
DIED:Y
DATEDIED:14 October 2021
L_THREAT:Y
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:N
LAB_DATA:
V_ADMINBY:OTH
OTHER_MEDS:
CUR_ILL:
HISTORY:Medical History/Concurrent Conditions: Cardiomyopathy (Detected at autopsy); Distal arthrogryposis
PRIOR_VAX:
SPLTTYPE:DEPFIZER INC202101531353
FORM_VERS:2
TODAYS_DATE:11 November 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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