VAERS ID: 1242573

AGE: 15| SEX: M|STATE: CO

Description

Heart failure

Symptoms

Cardiac failure, Death

Vaccines

VAX DATE: 04-18-2021| ONSET DATE: 04-19-2021| DAYS TO ONSET: 1
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH IM RA

RECVDATE:04-22-2021
RPT_DATE:
CAGE_YR:15
CAGE_MO:
DIED:Y
DATEDIED:04-20-2021
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:PUB
OTHER_MEDS:Vaccinated with Pfizer/Biontech, died 04/20/2021, 2 days after vaccination
CUR_ILL:No
HISTORY:No
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:04-22-2021
BIRTH_DEFECT:U
OFC_VISIT:Y
ER_ED_VISIT:U
ALLERGIES:Nothing
V_FUNDBY:

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