VAERS ID: 1825618

AGE: 12| SEX: F|STATE: GA (United States)

Description

Developed MIS-C

Open in Wayback Machine
(If this is a foreign report without a description you will be able to read the description in the Wayback Machine on Medalerts if the report became public for the first time before November 18, 2022.)

Symptoms

Red blood cell sedimentation rate increased, Alanine aminotransferase increased, Blood urea increased, Electrocardiogram abnormal, Blood creatinine increased, C-reactive protein increased, Echocardiogram abnormal, Brain natriuretic peptide increased, Fibrin D dimer increased, Serum ferritin increased, Multisystem inflammatory syndrome in children

Vaccines

VAX DATE: 09-30-2021| ONSET DATE: 10-13-2021| DAYS TO ONSET: 13
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH FC3183 IM UN
COVID19 (COVID19 (PFIZER-BIONTECH)) 2 COVID19 PFIZER\BIONTECH FC3183 IM UN

RECVDATE:10-28-2021
RPT_DATE:
CAGE_YR:12
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:4
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:BUN, Creatinine, BNP, ALT, Ferritin, DDimer, CRP, and ESR all elevated. EKG and ECHO abnormal.
V_ADMINBY:PVT
OTHER_MEDS:none
CUR_ILL:none
HISTORY:none
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:10-28-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:NKA
V_FUNDBY:

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