VAERS ID: 1225942

AGE: 16| SEX: F|State: WI

Description

Patient was a 16yr female who received Pfizer vaccine 3/19/21 at vaccine clinic and presented with ongoing CPR to the ED 3/28/21 after cardiac arrest at home. Patient placed on ECMO and imaging revealed bilateral large pulmonary embolism as likely etiology of arrest. Risk factors included oral contraceptive use. Labs have since confirmed absence of Factor V leiden or prothrombin gene mutation. Patient declared dead by neurologic criteria 3/30/21.

Symptoms

Cardiac arrest, Pulmonary embolism, Death, Resuscitation, Laboratory test, Lung assist device therapy, Oral contraception

Vaccines

VAX DATE: 18 March 2021 | ONSET DATE: 27 March 2021 | DAYS TO ONSET: 9
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))

        RECVDATE:
        17 April 2021
        CAGE_YR:
        16
        CAGE_MO:
        RPT_DATE:
        DIED:
        Y
        DATEDIED:
        29 March 2021
        L_THREAT:
        ER_VISIT:
        HOSPITAL:
        HOSPDAYS:
        X_STAY:
        DISABLE:
        RECOVD:
        N
        LAB_DATA:
        V_ADMINBY:
        UNK
        OTHER_MEDS:
        Reported to be on Drospirenone-Ethinyl Estradiol 3-0.02 MG per tab
        CUR_ILL:
        HISTORY:
        PRIOR_VAX:
        SPLTTYPE:
        FORM_VERS:
        2
        TODAYS_DATE:
        17 April 2021
        BIRTH_DEFECT:
        OFC_VISIT:
        ER_ED_VISIT:
        ALLERGIES:
        V_FUNDBY: