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History of Changes from the VAERS Wayback Machine |
VAERS ID: | 1243516 |
VAERS Form: | 2 |
Age: | 16.0 |
Sex: | Female |
Location: | Wisconsin |
Vaccinated: | 2021-03-19 |
Onset: | 2021-03-28 |
Submitted: | 0000-00-00 |
Entered: | 2021-04-22 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | RT2613 / 1 | UN / IM |
Administered by: Private Purchased by: ??
Symptoms: Cardiac arrest, Circulatory collapse, Death, Pulmonary embolism, Computerised tomogram thorax abnormal, Lung assist device therapy
Life Threatening? No
Birth Defect? No
Died? Yes
Date died:2021-03-30
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Oral contraceptives Sertraline Loratadine Fluticasone Doxycycline, albuterol
Current Illness: Asthma, ADHD, Anxiety
Preexisting Conditions:
Allergies: NKDA
Diagnostic Lab Data: Bilateral PE on CT Scan
CDC 'Split Type':
Write-up: Hemodynamic collapse at home. Persistent cardiac arrest requiring ECMO. Event believed secondary to pulmonary embolism. Death by neurologic criteria.
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