VAERS ID: |
930912 (history) |
Form: |
Version 2.0 |
Age: |
73.0 |
Sex: |
Male |
Location: |
New York |
Vaccinated: | 2021-01-07 |
Onset: | 2021-01-08 |
Days after vaccination: | 1 |
Submitted: |
0000-00-00 |
Entered: |
2021-01-09 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
UN / UN |
Administered by: Unknown Purchased by: ? Symptoms: Death,
Diarrhoea SMQs:, Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2001-01-08
Days after onset: 7305
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: None Current Illness: None Preexisting Conditions: None Allergies: None Diagnostic Lab Data: CDC Split Type:
Write-up: Diarrhea followed by death 24 hrs after vaccination |