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This is VAERS ID 1382906

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/18/2021

VAERS ID: 1382906
VAERS Form:2
Age:15.0
Sex:Male
Location:California
Vaccinated:2021-05-15
Onset:2021-06-07
Submitted:0000-00-00
Entered:2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-07
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None known
Current Illness: none noted
Preexisting Conditions: Acne, no other conditions noted
Allergies: None noted
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Unexplained death within 48 hours

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