VAERS ID: |
1975356 (history) |
Form: |
Version 2.0 |
Age: |
7.0 |
Sex: |
Female |
Location: |
Minnesota |
Vaccinated: | 2021-11-29 |
Onset: | 2021-12-10 |
Days after vaccination: | 11 |
Submitted: |
0000-00-00 |
Entered: |
2021-12-23 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
FK51227 / 1 |
LA / SYR |
Administered by: Other Purchased by: ? Symptoms: Autopsy,
Cough,
Exposure to communicable disease,
Influenza virus test positive,
Pyrexia,
Respiratory arrest,
Respiratory tract congestion,
Resuscitation,
SARS-CoV-2 test negative,
Unresponsive to stimuli SMQs:, Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-12-10
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Other Medications: None Current Illness: Fever, vomiting on 11/25 - lasted 24-48 hours Other family members had similar symptoms Preexisting Conditions: None Allergies: None known Diagnostic Lab Data: COVID pcr negative 12/9/2021 CDC Split Type:
Write-up: Patient developed fever on 12/9/2021, with mild cough and congestion. Was treated at home with acetaminophen at approximately 12:30 pm, ibuprofen at 7:30 pm. Entire family was sick with similar symptoms. 2 siblings were positive for influenza and strep, Patient was not tested for either of those. 12/9 had a COVID pcr test done - negative. On 12/10/21 mom went to check on her in the morning at 9:15, found patient n bed, not breathing, unresponsive. Attempted CPR with no response. Final autopsy report pending. Parents report they received a call from medical examiner notifying ten that patient was tested + for influenza on post-mortem. |