| VAERS ID: |
946959 (history) |
| Form: |
Version 2.0 |
| Age: |
83.0 |
| Sex: |
Male |
| Location: |
North Carolina |
| Vaccinated: | 2021-01-14 |
| Onset: | 2021-01-15 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-15 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EL3249 / 1 |
LA / IM |
Administered by: Public Purchased by: ? Symptoms: Autopsy,
Sudden death SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-01-15
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: Current Illness: Post COVID-19 complications, A-fib, CHF Preexisting Conditions: Diabetes, Allergies: None Diagnostic Lab Data: Unsure, autopsy pending CDC Split Type:
Write-up: Sudden death 18 hours post vaccine . |