This is VAERS ID 2233852

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/15/2022

Vaccin­ation / Manu­facturer (2 vaccines)	Lot / Dose	Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH	FL0007 / UNK	AR / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC.	309622 / UNK	AR / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Abdominal pain, Blood fibrinogen increased, C-reactive protein increased, Cardiogenic shock, Chest pain, Diarrhoea, Fibrin D dimer increased, Intensive care, Pyrexia, Serum ferritin increased, Vomiting, Conjunctival hyperaemia, Multi-organ disorder, Troponin increased, Immunoglobulin therapy, Inflammatory marker increased, N-terminal prohormone brain natriuretic peptide increased, COVID-19, SARS-CoV-2 test positive, SARS-CoV-2 antibody test positive, Multisystem inflammatory syndrome in children

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: (blank)
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: MIS-C onset same day as vaccination
Preexisting Conditions: N/A
Allergies: Unknown
Diagnostic Lab Data: COVID-19 Ab Nucleocapsid and Spike positive (12/21/21), COVID-19 PCR positive (12/21/21), elevated inflammatory markers (12/21/21-12/24/21) - see continuation page for lab results Fibrinogen - 602 mg/dL, CRP - 121 mg/L, Ferritin - 304 mcg/L, Troponin - 64 ng/L, NT-proBNP - 3135 ng/L, D-dimer - 1040 ng/mL
CDC 'Split Type':

Write-up: Case-patient had first Pfizer COVID-19 vaccine on 12/18/2021 and illness onset for MIS-C was on the same day. Case had COVID-19 with mild symptoms approximately 4 weeks before MIS-C onset. Case-patient met case definition for MIS-C with evidence of clinically severe illness requiring hospitalization, fever, multisystem organ involvement (cardiac, hematologic, & GI). The case-patient experienced cardiac shock, chest pain, abdominal pain, vomiting, diarrhea, conjunctival injection, and various elevated inflammatory markers (see box 19 below). Case-patient was treated with IVIG, ASA, steroids, and epinephrine and survived after a 4 day hospitalization (1 day in PICU).

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Changed on 4/22/2022

(Changed: Diagnostic Lab Data)

Vaccin­ation / Manu­facturer (2 vaccines)	Lot / Dose	Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH	FL0007 / UNK	AR / SYR
FLUC4: INFLUENZA (SEASONAL) (FLUCELVAX QUADRIVALENT) / SEQIRUS, INC.	309622 / UNK	AR / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Abdominal pain, Blood fibrinogen increased, C-reactive protein increased, Cardiogenic shock, Chest pain, Diarrhoea, Fibrin D dimer increased, Intensive care, Pyrexia, Serum ferritin increased, Vomiting, Conjunctival hyperaemia, Multi-organ disorder, Troponin increased, Immunoglobulin therapy, Inflammatory marker increased, N-terminal prohormone brain natriuretic peptide increased, COVID-19, SARS-CoV-2 test positive, SARS-CoV-2 antibody test positive, Multisystem inflammatory syndrome in children

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: (blank)
    Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: MIS-C onset same day as vaccination
Preexisting Conditions: N/A
Allergies: Unknown
Diagnostic Lab Data: COVID-19 Ab Nucleocapsid and Spike positive (12/21/21), COVID-19 PCR positive (12/21/21), elevated inflammatory markers (12/21/21-12/24/21) - see continuation page Additional information for lab results Item 19: From Question 19: Fibrinogen - 602 mg/dL, CRP - 121 mg/L, Ferritin - 304 mcg/L, Troponin - 64 ng/L, NT-proBNP - 3135 ng/L, D-dimer - 1040 ng/mL Fibrinogen - 602 mg/dL, CRP - 121 mg/L, Ferritin - 304 mcg/L, Troponin - 64 ng/L, NT-proBNP - 3135 ng/L, D-dimer - 1040 ng/mL
CDC 'Split Type':

Write-up: Case-patient had first Pfizer COVID-19 vaccine on 12/18/2021 and illness onset for MIS-C was on the same day. Case had COVID-19 with mild symptoms approximately 4 weeks before MIS-C onset. Case-patient met case definition for MIS-C with evidence of clinically severe illness requiring hospitalization, fever, multisystem organ involvement (cardiac, hematologic, & GI). The case-patient experienced cardiac shock, chest pain, abdominal pain, vomiting, diarrhea, conjunctival injection, and various elevated inflammatory markers (see box 19 below). Case-patient was treated with IVIG, ASA, steroids, and epinephrine and survived after a 4 day hospitalization (1 day in PICU).

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