VAERS ID: 2001194

AGE: 10| SEX: M|STATE: NE (United States)

Description

Patient received second dose of Pfizer Covid19 vaccine on 12/18/2021. Lot number FL0007. Patient first developed MIS-C symptoms on 12/24/2021, became febrile on 12/27/2021, and was subsequently hospitalized in the ICU on 12/29/2021. Patient experienced mild perihilar peribronchial cuffing, volume loss at lung bases, mildly suppressed systolic function,abnormal LV longitudinal strain. Evidence of cardiac, hematologic and gastrointestinal organ involvement (shock, hypotension, elevated troponin, chest pain/tightness, elevated d-dimers, abdominal pain, nausea, vomiting, diarrhea, elevated liver enzymes, conjunctival infection and periorbital edema.

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Symptoms

Pyrexia, Hypotension, Vomiting, Nausea, Abdominal pain, Diarrhoea, Conjunctivitis, Chest pain, Lung disorder, Shock, Chest discomfort, Intensive care, Periorbital oedema, C-reactive protein increased, Hepatic enzyme increased, Troponin increased, Left ventricular dysfunction, Fibrin D dimer increased, Bronchial wall thickening, Multi-organ disorder, N-terminal prohormone brain natriuretic peptide increased, Systolic dysfunction, Multisystem inflammatory syndrome in children

Vaccines

VAX DATE: 11-27-2021| ONSET DATE: 12-24-2021| DAYS TO ONSET: 27
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH FK5618 IM UN

RECVDATE:01-04-2022
RPT_DATE:
CAGE_YR:10
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:7
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:CRP: 22.6 mg/dL Troponin 0.985 ng/ml, NT-proBNP 6350 pg/ml, 4086 ng/ml,
V_ADMINBY:PVT
OTHER_MEDS:
CUR_ILL:Covid-like illness 11/11/2021
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:01-04-2022
BIRTH_DEFECT:U
OFC_VISIT:Y
ER_ED_VISIT:U
ALLERGIES:
V_FUNDBY:

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