VAERS ID: 1953860

AGE: 17| SEX: M|STATE: FR (Unknown)

Description

Headache; Vomiting; body weakness; This is a spontaneous report received from a contactable reporter(s) (Other healthcare professional) from Regulatory Authority. Regulatory number: PH-PHFDA-300121470 (Regulatory Authority). A 17 year-old male patient received bnt162b2 (COMIRNATY), intramuscular, administration date 10Nov2021 (Lot number: PCB0002) at the age of 17 years asDOSE NUMBER UNKNOWN, SINGLE for covid-19 immunisation. The patient's relevant medical history and concomitant medications were not reported. The following information was reported: HEADACHE (death) with onset 17Nov2021, outcome "fatal", described as "Headache"; VOMITING (death) with onset 17Nov2021, outcome "fatal", described as "Vomiting"; ASTHENIA (death) with onset 17Nov2021, outcome "fatal", described as "body weakness". The patient date of death was unknown. The reported cause of death was headache, vomiting, asthenia. No follow-up attempts are possible. No further information is expected.; Reported Cause(s) of Death: headache; vomiting; body weakness

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Symptoms

Headache, Vomiting, Asthenia

Vaccines

VAX DATE: 11-10-2021| ONSET DATE: 11-17-2021| DAYS TO ONSET: 7
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 0 COVID19 PFIZER\BIONTECH PCB0002 OT Unknown

RECVDATE:12-16-2021
RPT_DATE:
CAGE_YR:
CAGE_MO:
DIED:Y
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:OTH
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:PHPFIZER INC202101711255
FORM_VERS:
TODAYS_DATE:12-15-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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