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This is VAERS ID 1383620

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1383620
VAERS Form:2
Age:15.0
Sex:Male
Location:California
Vaccinated:2021-06-05
Onset:2021-06-06
Submitted:0000-00-00
Entered:2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Sudden death

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-06
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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Sudden death one day after recieving 2nd dose of Pfizer Covid Vaccine (6/6/21). Found dead.


Record is removed as of 6/18/2021

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