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This is VAERS ID 1243516

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History of Changes from the VAERS Wayback Machine

Color Schemes (Before/After):

First Appeared on 4/23/2021

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.


Record is removed as of 4/30/2021

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