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VAERS ID: 1953855

AGE: 14| SEX: F|State: FR

Description

Dyspnea; Vomiting; Body pain; Fever; Muscle pain; Chills; This is a spontaneous report received from a contactable Other HCP from Regulatory Authority. Regulatory number: PH-PHFDA-300121720 Regulatory Authority. A 14 year-old female patient received bnt162b2 (COMIRNATY), intramuscular, administration date 18Nov2021 (Lot number: PAA1733483202180) at the age of 14 years as single dose for covid-19 immunisation. The patient's relevant medical history and concomitant medications were not reported. The following information was reported: DYSPNOEA (death, hospitalization) with onset 23Nov2021 08:20, outcome "fatal", described as "Dyspnea"; VOMITING (death, hospitalization) with onset 19Nov2021 19:00, outcome "fatal", described as "Vomiting"; PYREXIA (non-serious) with onset 18Nov2021 20:00, outcome "recovered" (18Nov2021 21:00), described as "Fever"; MYALGIA (non-serious) with onset 18Nov2021 20:00, outcome "recovered" (18Nov2021 21:00), described as "Muscle pain"; CHILLS (non-serious) with onset 18Nov2021 20:00, outcome "recovered" (18Nov2021 21:00), described as "Chills"; PAIN (non-serious) with onset 23Nov2021 08:20, outcome "unknown", described as "Body pain". It reported 19Nov2021 night time: fever and vomiting; 20Nov2021 night time: fever and vomiting; 21Nov2021: No signs and symptoms; 22Nov2021 between 10-11:00 PM: Vomiting; 23Nov2021 8:20 AM: Difficulty of breathing, Vomiting (2x), Body pain. The patient date of death was 2021. The reported cause of death was dyspnoea, vomiting. It was not reported if an autopsy was performed. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: Dyspnea; Vomiting

Symptoms

Body temperature, Pyrexia, Chills, Vomiting, Dyspnoea, Myalgia, Pain

Vaccines

VAX DATE: 17 November 2021 | ONSET DATE: 17 November 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • UNK
  • OT
  • PAA173348320218

RECVDATE:15 December 2021
CAGE_YR:
CAGE_MO:
RPT_DATE:
DIED:Y
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:N
LAB_DATA:Test Date: 20211118; Test Name: body temperature; Result Unstructured Data: Test Result:Fever; Comments: 20:00
V_ADMINBY:OTH
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:PHPFIZER INC202101711249
FORM_VERS:2
TODAYS_DATE:13 December 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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