VAERS ID: 1505250

AGE: 13| SEX: F|State: MD

Description

patient arrived in ventricular tachycardia via EMS, but responsive. deteoriarated to pulseless ventricular tachycardia, PEA and ultimately death.

Symptoms

Blood glucose increased, SARS-CoV-2 test negative, Death, Ventricular tachycardia, Full blood count, Metabolic function test normal, Pulseless electrical activity

Vaccines

VAX DATE: 30 June 2021 | ONSET DATE: 26 July 2021 | DAYS TO ONSET: 26
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))

        RECVDATE:
        26 July 2021
        CAGE_YR:
        13
        CAGE_MO:
        RPT_DATE:
        DIED:
        Y
        DATEDIED:
        26 July 2021
        L_THREAT:
        ER_VISIT:
        HOSPITAL:
        HOSPDAYS:
        X_STAY:
        DISABLE:
        RECOVD:
        N
        LAB_DATA:
        CBC, CMP normal except slightly elevated glucose COVID PCR negative
        V_ADMINBY:
        PVT
        OTHER_MEDS:
        one dose of dramamine given in the evening prior to arrival.
        CUR_ILL:
        none
        HISTORY:
        none, remote history of asthma
        PRIOR_VAX:
        SPLTTYPE:
        FORM_VERS:
        2
        TODAYS_DATE:
        26 July 2021
        BIRTH_DEFECT:
        OFC_VISIT:
        ER_ED_VISIT:
        ALLERGIES:
        none
        V_FUNDBY: