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VAERS ID: 1861598

AGE: 7| SEX: M|State: VA

Description

About 3 hours after receiving the vaccine, he presented in cardiogenic shock with tachycardia and hypotension. He was found to have severe LV dysfunction and is currently on ECMO. I would like to stress that he did have symptoms preceding receiving the vaccine, but felt that given the clinical decompensation that it should be reported and investigated.

Symptoms

Aortic valve incompetence, Echocardiogram abnormal, Mitral valve incompetence, Tachycardia, Borrelia test negative, Ejection fraction decreased, Pericardial effusion, Tricuspid valve incompetence, Cardiac valve disease, Hypotension, Respiratory viral panel, Viral test negative, Cardiogenic shock, Left ventricular dysfunction, SARS-CoV-2 antibody test negative, Echocardiogram, Lung assist device therapy, Systolic dysfunction

Vaccines

VAX DATE: 08 November 2021 | ONSET DATE: 08 November 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • PFIZERBIONTECH
  • COVID19 (COVID19 (PFIZER-BIONTECH))
  • 1
  • IM
  • LA
  • FK5618

RECVDATE:
10 November 2021
CAGE_YR:
7
CAGE_MO:
RPT_DATE:
DIED:
DATEDIED:
L_THREAT:
Y
ER_VISIT:
HOSPITAL:
Y
HOSPDAYS:
2
X_STAY:
DISABLE:
RECOVD:
N
LAB_DATA:
Initial TTE - 11/10/21 Summary * Structurally normal heart. * Moderate tricuspid regurgitation. * Moderate mitral regurgitation. * Normal RV pressures based on TR jet velocity and septal contour. * Normal LV size and wall thickness though moderately depressed systolic function (mmode SF 26%, mmode EF 49%, 2D EF 42%, Bullet EF 42%). * Trivial pericardial effusion posteriorly, along RV free wall. Echo 11/11/21 - Summary * Patient with history of ECMO placement (November 10, 2021). Transesophageal echocardiogram to evaluate ECMO cannulae. * Globally qualitatively severely depressed biventricular systolic function. * Aortic cannula tip is in mid ascending aorta. * Trivial+ aortic insufficiency. * Moderate mitral valve regurgitation from central coaptation defect. * Venous cannula tip in the RA and IVC junction. 11/10/21 - SARS-CoV-2 antibodies negative; Respiratory panel negative; Lyme screen negative
V_ADMINBY:
PVT
OTHER_MEDS:
Tylenol, motrin, zyrtec, zofran, miralax
CUR_ILL:
Yes, abdominal pain preceded the vaccination on 11/5 and diarrhea on 11/7. He had increased fatigue/lethargy prior to receiving the vaccine.
HISTORY:
none
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
2
TODAYS_DATE:
10 November 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
None
V_FUNDBY:
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