| VAERS ID: |
1505250 (history) |
| Form: |
Version 2.0 |
| Age: |
13.0 |
| Sex: |
Female |
| Location: |
Maryland |
| Vaccinated: | 2021-07-01 |
| Onset: | 2021-07-27 |
| Days after vaccination: | 26 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-07-27 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / UNK |
- / - |
Administered by: Private Purchased by: ?
Symptoms: Blood glucose increased,
Death,
Full blood count,
Metabolic function test normal,
Pulseless electrical activity,
SARS-CoV-2 test negative,
Ventricular tachycardia
SMQs:, Torsade de pointes/QT prolongation (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Ventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Cardiac arrhythmia terms, nonspecific (narrow), COVID-19 (broad), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-07-27
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: one dose of dramamine given in the evening prior to arrival.
Current Illness: none
Preexisting Conditions: none, remote history of asthma
Allergies: none
Diagnostic Lab Data: CBC, CMP normal except slightly elevated glucose COVID PCR negative
CDC Split Type:
Write-up: patient arrived in ventricular tachycardia via EMS, but responsive. deteoriarated to pulseless ventricular tachycardia, PEA and ultimately death. |
