VAERS ID: 2177682

AGE: 14| SEX: M|STATE: AR

Description

hospitalization; covid positive fully vaccinated

Symptoms

COVID-19, SARS-CoV-2 test positive

Vaccines

VAX DATE: 08-08-2021| ONSET DATE: 03-10-2022| DAYS TO ONSET: 214
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 2 COVID19 PFIZER\BIONTECH FC3180 IM RA

RECVDATE:03-14-2022
RPT_DATE:
CAGE_YR:14
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:U
HOSPITAL:Y
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:U
LAB_DATA:positive covid antigen test 3/9/22
V_ADMINBY:PVT
OTHER_MEDS:unknown
CUR_ILL:unknown
HISTORY:unknown
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:03-14-2022
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:amoxicillin
V_FUNDBY:

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