| VAERS ID: |
1420630 (history) |
| Form: |
Version 2.0 |
| Age: |
16.0 |
| Sex: |
Female |
| Location: |
Pennsylvania |
| Vaccinated: | 2021-03-13 |
| Onset: | 2021-04-03 |
| Days after vaccination: | 21 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-06-23 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
- / 1 |
UN / IM |
Administered by: Private Purchased by: ?
Symptoms: Chest pain,
Death,
General physical health deterioration,
Haemophagocytic lymphohistiocytosis,
Pericardial effusion
SMQs:, Systemic lupus erythematosus (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow), Noninfectious myocarditis/pericarditis (broad)
Life Threatening? No
Birth Defect? No
Died? Yes
Date died: 2021-06-15
Days after onset: 73
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 32 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: Artane, azithromycin, calcium carbonate, dicyclomine, doxycycline, escitalopram, flovent, gabapentin, lansoprazole, melatonin, ondansetron, tedizolid,
Current Illness: disseminated mycobacterium chelonae infection
Preexisting Conditions: ataxia telangiectasia; EBV-associated lymphoma
Allergies: none
Diagnostic Lab Data:
CDC Split Type:
Write-up: ~4 weeks after the 2nd dose of Pfizer, patient presented to the hospital with chest pain; had pericardial effusion. Initially improved but then had decompensation, prolonged hospitalization. Diagnosed with hemophagocytic lymphohistocytosis (HLH) and ultimately died. |
