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From the 11/26/2021 release of VAERS data:

Found 253 cases where Age is under-19 and Vaccine is COVID19 and Manufacturer is PFIZER/BIONTECH and Patient Did Not Die and Hospitalized and Vaccination Date from '2021-07-01' to '2021-07-31'

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Case Details

This is page 12 out of 26

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VAERS ID: 1694372 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-07-24
Onset:2021-08-03
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0181 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7484 / 2 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood electrolytes normal, C-reactive protein normal, Cardiac function test normal, Echocardiogram, Full blood count normal, Liver function test normal, Malaise, Pericardial effusion, Troponin normal
SMQs:, Systemic lupus erythematosus (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lexapro, Ativan, Linzes, Trazadone
Current Illness: Covid 19 started July 2020
Preexisting Conditions: None
Allergies: Pennicillin
Diagnostic Lab Data: Echocardiogram, Normal CBC and Electrolytes and LFT. Normal Troponin, Normal CRP
CDC Split Type:

Write-up: Pericardial effusion, normal troponin, normal cardiac function. Malaise on 8/17/2021


VAERS ID: 1694434 (history)  
Form: Version 2.0  
Age: 14.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-15
Onset:2021-09-09
   Days after vaccination:56
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0196 / 2 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Adenovirus test, Alanine aminotransferase increased, Arteriogram coronary normal, Aspartate aminotransferase increased, Blood creatine phosphokinase increased, Blood fibrinogen increased, Blood lactate dehydrogenase increased, Blood triglycerides normal, C-reactive protein increased, Cardiac imaging procedure abnormal, Chest pain, Cytomegalovirus test negative, Discomfort, Echocardiogram abnormal, Ejection fraction decreased, Electrocardiogram ST segment elevation, Enterovirus test negative, Epstein-Barr virus test, Fibrin D dimer increased, Full blood count normal, Hepatic steatosis, Immunoglobulin therapy, Inflammation, Laboratory test, Left ventricular dilatation, Left ventricular dysfunction, Liver function test increased, Metabolic function test normal, Mitral valve incompetence, Myocarditis, N-terminal prohormone brain natriuretic peptide increased, Oedema, Parvovirus B19 test negative, Pericarditis, Respiratory viral panel, SARS-CoV-2 test negative, Stool analysis, Troponin increased, Ultrasound liver abnormal, Ventricular hypokinesia
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (narrow), Chronic kidney disease (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: cholecalciferol 2000 iu qday
Current Illness: Elevated transaminases found in July 2021 - unknown etiology
Preexisting Conditions: obesity, elevated cholesterol, vitamin D deficiency
Allergies: NKA
Diagnostic Lab Data: CBC/BMP 9/9/21 ? all within normal limits AST/ALT (unit/L): 9/9/21 ? 479/238 ; 9/10/21 ? 218/150 ; 9/12/21 ? 113/117 NT pro BNP: 9/9/21 - 596 CRP (mg/dL): 9/9/21 ? 1.8 CK (units/L): 9/9/21 ? 21,100 ; 9/10/21 - 7467; 9/11/21 - 4778; 9/12/21 ?6039 ; 9/13/21 - 5927 LDH (unit/L): 9/9/21 ? 2613; 9/10/21 ? 1758 Troponin: 9/9/21 - 45.9; 9/10/21 -41.5 ; 9/11/21 -13; 9/12/21 ? 1.3 ; 9/13/21 ? 0.8 Triglycerides ? 9/9/21- 83 D-Dimer 9/9/21 ? 0.66 Fibrinogen (mg/dl)-9/9/21 - 391 9/9/21 blood PCRs (adenovirus, parvovirus, SARS Cov2, CMV, enterovirus) ? all negative 9/9/21 EBV and HHV6 blood PCRs, gastrointestinal stool panel = pending 9/9/21 respiratory viral panel = negative 9/9/21 Cardiac MRI = Subepicardial delayed postcontrast enhancement within the lateral and inferolateral left ventricular walls in a nonischemic regional distribution and global relative increased signal of the myocardium relative to skeletal muscle suggestive of edema. In the setting of clinically suspected myocarditis, cardiac MRI findings are consistent with myocardial inflammation. Mild enhancement of the pericardium laterally which can correlate with pericarditis-myocarditis. Mildly depressed left ventricular function. Normal left ventricular size. Normal right ventricular size and function. 9/9/21 CT Angiogram Chest = Breathing artifact is present within the midportion of the exam which somewhat degrades the evaluation of the midportion of the RCA and distal LCA. Normal appearance of the coronary origins, course and caliber. 9/9/21 ECHO - Normal cardiac anatomy Dilated left ventricle, trivial, with mild global hypokinesis, LV ejection fraction 49% The right ventricle is grossly normal size with qualitatively trivial global hypokinesis Structurally normal mitral valve with trivial mitral regurgitation Tricuspid regurgitation gradient is not quantifiable for estimation of RV systolic pressure No pericardial effusion Possible right pleural effusion (image 34) - correlate with chest xray 9/13/21 ECHO (multiple ECHOs in between 9/9/21 and 9/13/21): Left ventricular strain quantification was clinically indicated based upon 2D Echo images. Left ventricular has trivial dysfunction with ejection fraction of 52% and global longitudinal strain of -17.5% (stable to subtle improvement) The right ventricle is grossly normal size with normal systolic function. No significant pericardial effusion.
CDC Split Type:

Write-up: Patient received 1st COVID-19 vaccine on 6/24/21 and 2nd COVID-19 vaccine on 7/15/21. Both at same pharmacy. He had a well child check in July which showed elevated LFTS on baseline labs ( AST was 148, ALT is 161). He was seen by hepatology who obtained a liver ultrasound which demonstrated Echogenic liver, most commonly seen with fatty infiltration. He then presented to our hospital on 9/8/21 with 2 days of chest pain, feeling like pressure, was intermittent, and sometimes sharp. Labs demonstrated significantly elevated AST/ALT, CK, troponin, NT pro BNP, fibrinogen, d-dimer, and CRP. EKG showed ST segment elevation. ECHO showed normal heart structure with EF of 49%. A gated CT angiogram showed normal coronaries. A cardiac MRI showed diffuse inflammation. He was admitted due to concerns for myocarditis and started on ibuprofen on 9/9/21. EKG obtained later in the day on 9/9 was normal. The patient received 70 g (1 g/kg) IVIG on 9/10/21 PM. Hepatology, rheumatology, genetics, and infectious diseases were consulted and recommended a variety of tests. An ECHO on 9/13 demonstrated an EF improved to 52%. The patient remains admitted.


VAERS ID: 1696197 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: California  
Vaccinated:2021-07-23
Onset:2021-08-13
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0173 / 1 RA / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0187 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Brain natriuretic peptide normal, C-reactive protein normal, Chest X-ray normal, Chest pain, Early repolarisation syndrome, Echocardiogram abnormal, Electrocardiogram abnormal, Full blood count normal, Metabolic function test, Myocarditis, Pain in extremity, Pyrexia, Troponin increased
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (narrow), Ventricular tachyarrhythmias (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: CMP, CBC, CRP, BNP, EKG, CXR reportedly unremarkable with troponin 1741 ECHO 8/16/21. Normal EKG (8/16/21) Normal.
CDC Split Type:

Write-up: Patient presented with myopericarditis on 8/16 to Medical Center, Emergency Department and was subsequently admitted for hospital admission from 8/16 to 8/17. Patient received 2nd dose of Pfizer COVID19 vaccine on 8/13. On 8/13 at night, the patient complained of subjective fever when going to sleep. On 8/14, in the morning, the patient complained of pain in the arm. On 8/15, in the morning, the patient began complaining of mild chest pain that was worse when laying down. On 8/15 at night and the following morning on 8/16, the patient complained of worsening chest pain that was aching, intermittent, without radiation on a scale of 8/10. Echo-cardiogram, EKG, and troponins were ordered. CMP, CBC, CRP, BNP, EKG, CXR reportedly unremarkable with troponin 1741 and received ibuprofen with relief of symptoms. Patient was admitted to Pediatric Floor and continued management. His troponin was 1741 on presentation and rose to 7,312 on 8/16. His echo and EKG were WNL, showing only early repolarization. Per cardiology EKG and Echo overall reassuring. Patient was treated with ibuprofen for symptomatic relief. Troponins downtrended before discharge. Follow up with PCP and Cardiology in one week from discharge.


VAERS ID: 1704473 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-07-29
Onset:2021-08-16
   Days after vaccination:18
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Private       Purchased by: ?
Symptoms: Contusion, Immunoglobulin therapy, Petechiae, Platelet count decreased
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Accidents and injuries (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none11
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: see item 18
CDC Split Type:

Write-up: 8/15/21-8/17/21 petechiae appearing on user body and extremities, followed by deep and extensive bruising from minimal contact. 8/18/21 Appointment with primary care physician, blood was drawn and platelet count was critically low at 3000 platelets per microliter of blood. 8/18/21 Emergency admission another blood test confirmed results above. Decision was made to begin IVIG therapy. 8/19/21 Discharged from Hospital with platelet count of 22,000 platelets per microliter of blood. 8/23/21 Another blood test with results of 20,000 platelets per microliter of blood 8/25/21 IVIG Therapy was given again. 8/27/21 Blood draw 74,000 platelets per microliter 9/15/21 Blood draw 120,000 platelets per microliter


VAERS ID: 1705028 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Nevada  
Vaccinated:2021-07-05
Onset:2021-07-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0217 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Catheterisation cardiac abnormal, Chest pain, Echocardiogram, Impaired work ability, Injection site erythema, Injection site swelling, Laboratory test, Myocardial infarction, Myocarditis, Pyrexia, X-ray
SMQs:, Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Extravasation events (injections, infusions and implants) (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 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Many tests occurred, some being a Hospital Echo and X-Ray The procedure that occurred is the Cardia Catheterization Procedures Diagnosed with myocarditis
CDC Split Type:

Write-up: Red swelling after the first dose in the upper left High fever after the second dose from 9:00 pm (approximately 5 hours after vaccination) on 7/5/21 till 12:30 pm on 7/7/21 Chest pains at 12:30 pm on 7/7/21. Went to the ER at 1:30 pm. Diagnosed with a heart attack with heart attack symptoms at 1:40 pm Many tests occurred, some being a Hospital Echo and X-Ray The procedure that occurred is the Cardia Catheterization Procedures Diagnosed with myocarditis Hospitalized for three days and two nights Medication: Colchicine (colchicine 0.6mg oral capsule)/ 1 cap by mouth/ once daily for one month Ibuprofen (ibuprofen 600mg oral tablet)/ 1 tab by mouth/ three times daily for one month PredniSONE (predniSONE 10mg oral tablet)/40mg PO daily x3 days/30 mg PO daily x3 days/20mg PO daily x3/10mg PO daily x3 days No physical activities or work for one month after discharge 2 months later, chest pains occur sometimes


VAERS ID: 1715721 (history)  
Form: Version 2.0  
Age: 12.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-07-29
Onset:2021-08-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EWO172 / 2 LA / -

Administered by: Other       Purchased by: ?
Symptoms: Computerised tomogram normal, Dysstasia, Fall, Gait disturbance, Gait inability, Laboratory test normal, Magnetic resonance imaging normal, Muscular weakness, SARS-CoV-2 test, X-ray
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: no
Current Illness: no
Preexisting Conditions: no
Allergies: NSAIDs
Diagnostic Lab Data: Tomography, magnetic resonance images, Miography, radiography, Covid test
CDC Split Type:

Write-up: Patient lost the strength of the legs to walk for 6 weeks, She could feel and move the legs but couldn? stand by her self. She lost the strength for one momento to an other, she was walking and felt down, since then she couldnt get up or walk by her self. She got a Tomography, magnetic resonance images, a Miography and there wasn?t any injury at he nervous system but muscles were without strength. She started with phisical Therapy and did it for 2 weeks. Suddenly for one moment to another she recovered the strength, of course her legs were a bit weak, and thinner than before


VAERS ID: 1722262 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-07-20
Onset:2021-08-01
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-09-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest pain, Chills, Diarrhoea, Hypotension, Malaise, Multisystem inflammatory syndrome in children, Pyrexia, Pyuria, SARS-CoV-2 test positive, Shock, Urine analysis abnormal, Vomiting
SMQs:, Anaphylactic reaction (narrow), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: per MIS-C Admissin summary: Pfizer vaccinated. 1st done 6/29/21 2nd dose 7/20/2021 per medical record. onset 8-1-2021 chest pain, subjective fever, chills and mailaise. vomiting and diarrhea. presented to ER and found hypotensive. Covid +, UA concerning for UTI. DC dx MIS-C, Hypotensive shock, Pyuria without UTI. admit 8/2-8/5.


VAERS ID: 1735798 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-07-01
Onset:2021-07-23
   Days after vaccination:22
Submitted: 0000-00-00
Entered: 2021-09-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA6780 / 2 RA / SC

Administered by: Public       Purchased by: ?
Symptoms: Abdominal X-ray, Blood bilirubin increased, Decreased appetite, Differential white blood cell count, Dizziness, Endoscopy, Faeces discoloured, Feeling hot, Full blood count, Liver scan, Melaena, Metabolic function test, Occult blood, Red blood cell count decreased, White blood cell count decreased
SMQs:, Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Gastrointestinal haemorrhage (narrow), Biliary system related investigations, signs and symptoms (narrow), Vestibular disorders (broad), Noninfectious diarrhoea (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuteral, Miralax, Famotadine
Current Illness: N/A
Preexisting Conditions: Asthma
Allergies: Pet Dander, Pollen
Diagnostic Lab Data: Upper Endoscopy, liver scan, abdominal xray, CBC with diff, CMP, stool samples for occult blood, and Total Bilirubin l level.
CDC Split Type:

Write-up: Initial adverse events feeling hot, dizziness, Event resolved 20-30 minutes post vaccination. Later experienced black tarry stools, low WBC, low RBC, high bilirubin levels, and loss of appetite.


VAERS ID: 1774984 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-07-29
Onset:2021-08-10
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FA7485 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Laboratory test, Multisystem inflammatory syndrome in children
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Toxic-septic shock conditions (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: not known
Current Illness:
Preexisting Conditions: Obesity (BMI 38.36)
Allergies: not known
Diagnostic Lab Data: Extensive labs
CDC Split Type:

Write-up: Pediatric Multisystem Inflammatory Syndrome


VAERS ID: 1774987 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Louisiana  
Vaccinated:2021-07-13
Onset:2021-07-28
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-10-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Laboratory test, Multisystem inflammatory syndrome in children
SMQs:, Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Toxic-septic shock conditions (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: not known
Current Illness:
Preexisting Conditions: Obesity (BMI 48.95)
Allergies: not known
Diagnostic Lab Data: Extensive labs
CDC Split Type:

Write-up: Pediatric Multisystem Inflammatory Syndrome following first dose of Pfizer vaccine


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