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))

        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: