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This is VAERS ID 1694568

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1694568
VAERS Form:2
Age:16.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-03-19
Onset:2021-03-28
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: Pulmonary embolism, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-30
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: 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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