VAERS ID: 1890705

AGE: 5| SEX: F|STATE: IA

Description

Due to patient's complex PMH, provider asked that patient be monitored overnight after administration of COVID vaccine. Patient was moved from PICU to general peds floor due to improvement in condition on Thursday. Vaccine was administered that evening. Patient did well. Remained on room air. Was discharged home on Saturday. On Monday morning, father checked on patient and she was found pulseless and not breathing. It is unclear whether or not patient was placed on home CPAP during the night. EMS called. Patient arrived to ED as a CPR in progress. Patient presented with a pH of <6. Last known well 9pm the evening prior. Patient expired at 11/22/21 at 11:05 CST.

Symptoms

Blood gases abnormal, Blood pH decreased, Carbon dioxide increased, Death, Intensive care, Pulse absent, Respiratory arrest, Resuscitation

Vaccines

VAX DATE: 11-18-2021| ONSET DATE: 11-22-2021| DAYS TO ONSET: 4
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH fk5127 IM RA

RECVDATE:11-22-2021
RPT_DATE:
CAGE_YR:5
CAGE_MO:
DIED:Y
DATEDIED:11-22-2021
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:Blood gas was done indicating pH<6, high CO2.
V_ADMINBY:PVT
OTHER_MEDS:albuterol nebs, baclofen, vitamin D, flonase, glycopyrrolate, levetiracetam, nystatin topical, phenobarbital, Miralax, azithromycin, PRN tylenol and ibuprofen
CUR_ILL:Recent admission for rhino/enterovirus, mycoplasma pneumoniae ab+ for acute respiratory failure.
HISTORY:PMH of twin to twin transfusion born at erm, neuroimaging showed significant loss of gray-white matter, hydrocephalus s/p VP shunt, spastic CP, seizure disorder. Use CPAP at home at night.
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:11-22-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:none known
V_FUNDBY:

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