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This is VAERS ID 1690103

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First Appeared on 9/17/2021

VAERS ID: 1690103
VAERS Form:2
Age:14.0
Sex:Male
Location:Foreign
Vaccinated:2021-07-27
Onset:2021-09-03
Submitted:0000-00-00
Entered:2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW2246 / 2 - / -

Administered by: Other      Purchased by: ??
Symptoms: Pulmonary oedema

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-09-03
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:
Current Illness:
Preexisting Conditions: Comments: List of non-encoded Patient Relevant History: Patient Other Relevant History 1: None
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': ESPFIZER INC202101170757

Write-up: pulmonary edema; This is a spontaneous report from a Pfizer-sponsored program, from a contactable consumer (patent''s uncle) through the Pfizer company doctor. A 14-year-old male patient received bnt162b2 (COMIRNATY), 1st dose on 06Jul2021 (Lot Number: EX0893) and 2nd dose on 27Jul2021 (Lot Number: EW2246, both via an unspecified route of administration as single dose for COVID-19 immunization. Medical history none. Concomitant medications were not reported. The patient experienced pulmonary edema (death) on 03Sep2021. The patient died on 03Sep2021. The autopsy revealed that the cause of death was pulmonary edema.; Reported Cause(s) of Death: pulmonary edema

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