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This is VAERS ID 1420630

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1420630
VAERS Form:2
Age:16.0
Sex:Female
Location:Pennsylvania
Vaccinated:2021-03-13
Onset:2021-04-03
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, Pericardial effusion, General physical health deterioration, Haemophagocytic lymphohistiocytosis

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-06-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 32     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.

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