VAERS ID: |
1242573 (history) |
Form: |
Version 2.0 |
Age: |
15.0 |
Sex: |
Male |
Location: |
Colorado |
Vaccinated: | 2021-04-18 |
Onset: | 2021-04-19 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
2021-04-22 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
RA / IM |
Administered by: Public Purchased by: ? Symptoms: Cardiac failure,
Death SMQs:, Cardiac failure (narrow), Cardiomyopathy (broad), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-04-20
Days after onset: 1
Permanent Disability? No
Recovered? No Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Vaccinated with Pfizer/Biontech, died 04/20/2021, 2 days after vaccination Current Illness: No Preexisting Conditions: No Allergies: Nothing Diagnostic Lab Data: CDC Split Type:
Write-up: Heart failure |