VAERS ID: |
1420762 (history) |
Form: |
Version 2.0 |
Age: |
17.0 |
Sex: |
Female |
Location: |
Unknown |
Vaccinated: | 2021-06-17 |
Onset: | 2021-06-23 |
Days after vaccination: | 6 |
Submitted: |
0000-00-00 |
Entered: |
2021-06-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Private Purchased by: ? Symptoms: Autopsy,
Cardiac arrest SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-06-23
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Other Medications: Vienva 0.1-20 mg-mcg per tablet Current Illness: No. Preexisting Conditions: Obesity, Family history of clotting disorder (her workup with negative), and depression. Allergies: NKDA Diagnostic Lab Data: CDC Split Type:
Write-up: Cardiac arrest without resuscitation. Unknown cause of cardiac arrest. Awaiting autopsy report. |