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This is VAERS ID 1689212

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1689212
VAERS Form:2
Age:17.0
Sex:Male
Location:Texas
Vaccinated:2021-04-17
Onset:2021-07-20
Submitted:0000-00-00
Entered:2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-08-29
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? Yes, days: 51     Extended hospital stay? No
Previous Vaccinations:
Other Medications: CETIRIZINE, ERGOCALCIFEROL,
Current Illness: STAGE IV TESTICULAR EMBRYONAL RHABDOMYOSARCOMA W/ LUNG & BONE METASTASES
Preexisting Conditions: SEE ABOVE
Allergies: VANCOMYCIN, TEMSIROLIMUS
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: SARS COV2 POSITIVE ON 7/20; EXPIRED 8/29/2021

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