VAERS ID: 2152560

AGE: 7| SEX: M|STATE: WA

Description

Patient presented to Emergency Department (ED) lethargic and listless. He proceeded to a shock state and had a cardiac arrest. He was not able to be resuscitated and died in the ED.

Symptoms

Atrioventricular block, Blood glucose normal, Blood lactic acid, Brain natriuretic peptide increased, Carbon dioxide decreased, Cardiac arrest, Death, Electrocardiogram QT prolonged, Electrocardiogram ST segment depression, Electrocardiogram T wave abnormal, Electrocardiogram T wave inversion, International normalised ratio increased, Lethargy, Listless, Prothrombin time prolonged, Pyrexia, QRS axis abnormal, Resuscitation, Shock, Troponin I increased, Vomiting

Vaccines

VAX DATE: 02-03-2022| ONSET DATE: 02-16-2022| DAYS TO ONSET: 13
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH FK5618 IM RA

RECVDATE:03-02-2022
RPT_DATE:
CAGE_YR:7
CAGE_MO:
DIED:Y
DATEDIED:02-16-2022
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:Notable Labs between 12:55 am and Glucose 180 mg/dl Electrolyte CO2 13 mmol/L Troponin I 26.97 ng/ml (0-0.4 nl range) PT 14.2 (nl 9.5-12.1 sec); INR 1.4 (0.9-1.1) BNP 2096 pg/nL ( 0-99 nl) Lactate 20 mmol/L (0-2.0 nl) Initial ECG Rate 151; right axis deviation; non-specific intra-ventricular conduction block; T wave inversion in inferior leads Later ECG Rate 86; Low voltage QRS, ST depression in inferior and anterolateral leads; non-specific T wave abnormality; borderline prolonged QT
V_ADMINBY:PVT
OTHER_MEDS:None
CUR_ILL:None noted. Emergency Department (ED) visit note stated that patient had a fever in the last 24 hours, had no respiratory symptoms but became lethargic. Vomited on way to the ED and was listless and lethargic on presentation. No history of rashes, ingestion or trauma.
HISTORY:None. Primary care visit in 2021 showed BMI 62
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:03-02-2022
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:Y
ALLERGIES:None
V_FUNDBY:

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