| VAERS ID: |
1386841 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Male |
| Location: |
Georgia |
| Vaccinated: | 2021-06-03 |
| Onset: | 2021-06-07 |
| Days after vaccination: | 4 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-09 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
AR / IM |
Administered by: Other Purchased by: ? Symptoms: Abdominal discomfort,
Condition aggravated,
Death,
Headache SMQs:, Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-06-07
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: Adderall Current Illness: Headache, upset stomach Preexisting Conditions: ADHD Allergies: NKDA Diagnostic Lab Data: Autopsy pending CDC Split Type:
Write-up: Prodrome of headache and gastric upset over 2 days following second dose. Then felt fine. Found the following day dead in bed. Autopsy pending |