VAERS ID: 1199455

AGE: 17| SEX: F|STATE: WI

Description

Patient reported difficulty breathing and chest pain; suffered cardiac arrest and death

Symptoms

Cardiac arrest, Chest pain, Death, Dyspnoea

Vaccines

VAX DATE: 04-02-2021| ONSET DATE: 04-10-2021| DAYS TO ONSET: 8
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) Unknown COVID19 PFIZER\BIONTECH Unknown Unknown

RECVDATE:04-12-2021
RPT_DATE:
CAGE_YR:17
CAGE_MO:
DIED:Y
DATEDIED:04-10-2021
L_THREAT:U
ER_VISIT:U
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:
V_ADMINBY:PVT
OTHER_MEDS:fluoxetine, fesoterodine, ortho-tricyclen, oxybutynin
CUR_ILL:NA
HISTORY:spina bifida, spinal meningocele, VP shunt, scoliosis, neurogenic bladder, constipation
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:04-12-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:Y
ALLERGIES:bananas, cephalexin, kiwi, mango, pineapple, latex
V_FUNDBY:

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