VAERS ID: 1261766

AGE: 1| SEX: M|STATE: FL

Description

increased body temperature, seizure, death

Symptoms

Body temperature increased, Death, Seizure

Vaccines

VAX DATE: 04-08-2021| ONSET DATE: 04-10-2021| DAYS TO ONSET: 2
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA IM LA

RECVDATE:04-27-2021
RPT_DATE:
CAGE_YR:1
CAGE_MO:0
DIED:Y
DATEDIED:04-10-2021
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:04-27-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:Y
ALLERGIES:
V_FUNDBY:

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