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VAERS ID: 1953860

AGE: 17| SEX: M|State: FR

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

Symptoms

Asthenia, Headache, Vomiting

Vaccines

VAX DATE: 09 November 2021 | ONSET DATE: 16 November 2021 | DAYS TO ONSET: 7
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • UNK
  • OT
  • PCB0002

RECVDATE:15 December 2021
CAGE_YR:
CAGE_MO:
RPT_DATE:
DIED:Y
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:N
LAB_DATA:
V_ADMINBY:OTH
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:PHPFIZER INC202101711255
FORM_VERS:2
TODAYS_DATE:14 December 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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