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VAERS ID: 1912785

AGE: 17| SEX: F|State: MN

Description

Dose 1 given 4/21/2021 Pfizer Lot # EW0172 Patient had a cardiac arrest at home and was pronounced dead at Emergency Room. Covid test was negative.

Symptoms

Cardiac arrest, Death, SARS-CoV-2 test negative

Vaccines

VAX DATE: 11 May 2021 | ONSET DATE: 11 May 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • 2
  • EW0175

RECVDATE:30 November 2021
CAGE_YR:17
CAGE_MO:
RPT_DATE:
DIED:Y
DATEDIED:29 November 2021
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:N
LAB_DATA:
V_ADMINBY:PVT
OTHER_MEDS:
CUR_ILL:
HISTORY:"complex medical history", patient had a trach and in home nursing care, no other information available at this time.
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:30 November 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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