VAERS ID: |
2377304 (history) |
Form: |
Version 2.0 |
Age: |
9.0 |
Sex: |
Female |
Location: |
California |
Vaccinated: | 2021-12-13 |
Onset: | 2021-12-27 |
Days after vaccination: | 14 |
Submitted: |
0000-00-00 |
Entered: |
2022-07-21 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
UN / SYR |
Administered by: Other Purchased by: ? Symptoms: Abdominal pain upper,
Chest pain,
Death,
Oropharyngeal pain SMQs:, Acute pancreatitis (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-12-27
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: Preexisting Conditions: Allergies: Diagnostic Lab Data: CDC Split Type:
Write-up: Death after 2-3 days of stomach ache, sore throat and chest pain; two weeks after receiving the vaccination |