VAERS ID: 1498080

AGE: 15| SEX: M|State: NY

Description

7/22/2021 Child collapsed on soccer field while playing soccer at a local camp. CPR was initiated immediately. EMS arrived and found patient in vtac. Shock x 5. ACLS, intubation attempted. Transported to Medical Center. Patient had covid in April 2021. Dx in May 2021 hypertrophic cardiomyopathy. Started on lopressor 25mg BID. Patient had reported to parents that he had not recently taken his medications. Patient had his second covid vaccine on Sunday 7/18/2021.

Symptoms

Resuscitation, Syncope, Ventricular tachycardia

Vaccines

VAX DATE: 17 July 2021 | ONSET DATE: 21 July 2021 | DAYS TO ONSET: 4
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
        RECVDATE:
        22 July 2021
        CAGE_YR:
        15
        CAGE_MO:
        RPT_DATE:
        DIED:
        Y
        DATEDIED:
        21 July 2021
        L_THREAT:
        ER_VISIT:
        HOSPITAL:
        Y
        HOSPDAYS:
        1
        X_STAY:
        DISABLE:
        RECOVD:
        N
        LAB_DATA:
        none at this time
        V_ADMINBY:
        PHM
        OTHER_MEDS:
        Lopressor 25mg BID
        CUR_ILL:
        Diagnosed May 2021 hypertrophic cardiomyopathy
        HISTORY:
        Diagnosed May 2021 hypertrophic cardiomyopathy
        PRIOR_VAX:
        SPLTTYPE:
        FORM_VERS:
        2
        TODAYS_DATE:
        22 July 2021
        BIRTH_DEFECT:
        OFC_VISIT:
        ER_ED_VISIT:
        Y
        ALLERGIES:
        unknown
        V_FUNDBY: