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VAERS ID: 1199455

AGE: 17| SEX: F|State: WI

Description

Patient reported difficulty breathing and chest pain; suffered cardiac arrest and death

Symptoms

Cardiac arrest, Chest pain, Death, Dyspnoea

Vaccines

VAX DATE: 01 April 2021 | ONSET DATE: 09 April 2021 | DAYS TO ONSET: 8
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • UNK

RECVDATE:11 April 2021
CAGE_YR:17
CAGE_MO:
RPT_DATE:
DIED:Y
DATEDIED:09 April 2021
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:N
LAB_DATA:
V_ADMINBY:PVT
OTHER_MEDS:fluoxetine, fesoterodine, ortho-tricyclen, oxybutynin
CUR_ILL:NA
HISTORY:spina bifida, spinal meningocele, VP shunt, scoliosis, neurogenic bladder, constipation
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:11 April 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:Y
ALLERGIES:bananas, cephalexin, kiwi, mango, pineapple, latex
V_FUNDBY:
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