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This is VAERS ID 1242573

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1242573
VAERS Form:2
Age:15.0
Sex:Male
Location:Colorado
Vaccinated:2021-04-18
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Cardiac failure, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vaccinated with Pfizer/Biontech, died 04/20/2021, 2 days after vaccination
Current Illness: No
Preexisting Conditions: No
Allergies: Nothing
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Heart failure


Changed on 5/7/2021

VAERS ID: 1242573 Before After
VAERS Form:2
Age:15.0
Sex:Male
Location:Colorado
Vaccinated:2021-04-18
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Cardiac failure, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vaccinated with Pfizer/Biontech, died 04/20/2021, 2 days after vaccination
Current Illness: No
Preexisting Conditions: No
Allergies: Nothing Nothing
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Heart failure


Changed on 5/14/2021

VAERS ID: 1242573 Before After
VAERS Form:2
Age:15.0
Sex:Male
Location:Colorado
Vaccinated:2021-04-18
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Cardiac failure, Death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-20
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vaccinated with Pfizer/Biontech, died 04/20/2021, 2 days after vaccination
Current Illness: No
Preexisting Conditions: No
Allergies: Nothing Nothing
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Heart failure

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