Adverse Event Reporting
| VAERS ID | 1486590 |
|---|---|
| Gender | Male |
| Age | 62 |
| StateCode | CA |
| Pharmaceutical Company | PFIZER\BIONTECH |
| Lot Number | EW0180 |
| Number of vaccinations | 1 |
| Vaccinated | 2021-06-25 |
| Onset | 2021-06-25 |
| Condition | Died |
Symptoms
- Death
Current Illness
Preexisting Conditions
Other Medications
Previous Vaccinations
Allergies
Laboratory Data
Write-up
Systemic: Patient was found at home passed away.
no autopsy was performed to determine cause of death-Severe, Additional Details: Patient received his vaccine from our pharmacy.
He waited for 15 minutes after vaccine and no adverse effects were reported.
Niece states he went home and was found passed away in his room two hours later