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: 07-18-2021| ONSET DATE: 07-22-2021| DAYS TO ONSET: 4
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH EW0196 IM LA
COVID19 (COVID19 (PFIZER-BIONTECH)) 2 COVID19 PFIZER\BIONTECH EW0198 IM LA

RECVDATE:07-23-2021
RPT_DATE:
CAGE_YR:15
CAGE_MO:
DIED:Y
DATEDIED:07-22-2021
L_THREAT:U
ER_VISIT:U
HOSPITAL:Y
HOSPDAYS:1
X_STAY:U
DISABLE:U
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:07-23-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:Y
ALLERGIES:unknown
V_FUNDBY:

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