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This is VAERS ID 1741267

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/1/2021

VAERS ID: 1741267
VAERS Form:2
Age:18.0
Sex:Male
Location:New York
Vaccinated:2021-08-26
Onset:2021-09-25
Submitted:0000-00-00
Entered:2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FC3182 / UNK - / IM

Administered by: Private      Purchased by: ??
Symptoms: Death, Pulmonary embolism, Autopsy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-09-25
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: Bacterial Epiglottitis
Preexisting Conditions: Obesity
Allergies: Unknown
Diagnostic Lab Data: Autopsy 9/27/2021
CDC 'Split Type':

Write-up: Patient died and preliminary autopsy revealed Massive pulmonary embolism

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