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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1694568



Case Details

VAERS ID: 1694568 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-19
Onset:2021-03-28
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Autopsy, Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: albuterol, Flovent, doxycycline, drospirenone and ethinyl estradiol, and Zoloft
Current Illness:
Preexisting Conditions: asthma
Allergies:
Diagnostic Lab Data: autopsy
CDC Split Type:

Write-up: pulmonary embolism


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=1694568

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