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))
        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: