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))

        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: