VAERS ID: |
2152560 (history) |
Form: |
Version 2.0 |
Age: |
7.0 |
Sex: |
Male |
Location: |
Washington |
Vaccinated: | 2022-02-03 |
Onset: | 2022-02-16 |
Days after vaccination: | 13 |
Submitted: |
0000-00-00 |
Entered: |
2022-03-02 |
Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
FK5618 / 1 |
RA / IM |
Administered by: Private Purchased by: ? 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 SMQs:, Torsade de pointes/QT prolongation (narrow), Cardiac failure (broad), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Depression (excl suicide and self injury) (broad), Other ischaemic heart disease (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Hypokalaemia (broad), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2022-02-16
Days after onset: 0
Permanent Disability? No
Recovered? No Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations: Other Medications: None Current Illness: 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. Preexisting Conditions: None. Primary care visit in 2021 showed BMI 62 Allergies: None Diagnostic 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 CDC Split Type:
Write-up: 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. |