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This is VAERS ID 1420762

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1420762
VAERS Form:2
Age:17.0
Sex:Female
Location:Unknown
Vaccinated:2021-06-17
Onset:2021-06-23
Submitted:0000-00-00
Entered:2021-06-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-23
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vienva 0.1-20 mg-mcg per tablet
Current Illness: No.
Preexisting Conditions: Obesity, Family history of clotting disorder (her workup with negative), and depression.
Allergies: NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Cardiac arrest without resuscitation. Unknown cause of cardiac arrest. Awaiting autopsy report.

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