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

Found 2,293 cases where Age is 12-or-more-and-under-18 and Vaccine targets COVID-19 (COVID19) and Serious

Government Disclaimer on use of this data



Case Details

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VAERS ID: 1207321 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-10
Onset:2021-03-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Computerised tomogram head, Dizziness, Fatigue, Laboratory test, Migraine, Pain in extremity, Pyrexia, Somnolence, Thrombophlebitis
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (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: Qvar
Current Illness: URI/Asthma (Not COVID)
Preexisting Conditions: Cough-variant asthma GERD
Allergies:
Diagnostic Lab Data: CT Brain Labwork
CDC Split Type:

Write-up: Severe, debilitating fatigue to the point of not being able to stay awake for more than a couple of hours a day. This continues, although minimally improved, 1 month out from 2nd vaccine Migraine-type headache- daily, continues 1 month out Dizziness Thrombophlebitis Initial low-grade fever and arm soreness resolved within 2 days


VAERS ID: 1212716 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Arizona  
Vaccinated:2021-04-03
Onset:2021-04-09
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: Balance disorder, Blood thyroid stimulating hormone normal, CSF glucose normal, CSF protein normal, CSF white blood cell count, Diplopia, Dizziness, Drug screen negative, Dysmetria, Gait disturbance, Guillain-Barre syndrome, Headache, Immunoglobulin therapy, Magnetic resonance imaging head abnormal, Miller Fisher syndrome, Mydriasis, SARS-CoV-2 test negative, Scan with contrast abnormal, Treponema test negative, Vision blurred, Vitamin D decreased
SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Glaucoma (broad), Demyelination (narrow), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Ocular motility disorders (narrow), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: 4 day gastrointestinal illness including vomiting, diarrhea, and fever 2 to 3 weeks prior to symptom onset
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: MR Orbit W/+W/O Contrast 04/11/2021 08:57 EXAM: MR Orbit W/+W/O Contrast, MR Brain W + W/O Contrast INDICATION: new onset blurry vision, mydriasis, double vision. COMPARISONS: CT head from 4/10/2021.TECHNIQU E: Multiplanar, multisequence MRI of the brain and orbits was performedbefore and after the uneventful administration of intravenous gadolinium-basedcontrast, dosage below. CONTRAST: 7 mL Gadavist. FINDINGS: BRAIN:Normal parenchymal signal intensity. No diffusion abnormality. No pathologicgradient susceptibility. Normal parenchymal volume and morphology.There is asymmetric enhancement of the right cisternal 6th cranial nerve and thevery proximal left sixth cranial nerve (series 22 image 3) as well as of thecisternal portion of the right 3rd cranial nerve (series 22 image 6). No evidence of hemorrhage. No extra-axial fluid collection. No midline shift.Basal cisterns maintained. Ventricles unremarkable. Central arterial flow voidspreserved.Calvarium unremarkable. Scalp soft tissues normal. ORBITS/FACE:Preseptal soft tissues normal. Globes unremarkable. Extraconal fat preserved.Extraocular muscles normal. There is mildly increased ill-defined hazyenhancement within the intraconal fat of the inferior right orbit, see series 22image 6 and series 21 image 6, only seen on the postcontrast images with noconfirmatory findings on the T1 precontrast or T2 sequences. Lacrimal glandsunremarkable. No abnormality in the region of the lacrimal sac.Optic nerves normal in morphology and signal intensity, no pathologicenhancement. No optic nerve sheath dilatation. Optic chiasm normal. Optic tractsnormal.Remaining facial soft tissues unremarkable. Visualized portions of theaerodigestive tract normal. Normal appearance of the regional vasculature. Novisualized enlarged or morphologically abnormal lymph nodes. Paranasal sinusesnormally aerated. Nasal septum is deviated to the right. Temporal bonestructures unremarkable.IMPRESSION: 1. Isolated enhancement of the right more than left 6th cranial nerves and ofthe right 3rd cranial nerve at the cisternal portions. This is nonspecific andmay be postinfectious or inflammatory. Acute demyelinating process such asMiller Fisher syndrome should also be clinically considered. No brainparenchymal abnormality.2. Subtle hazy enhancement within the intraconal fat of the right orbitinferiorly, which may be artifactual given the absence of abnormal findings onthe precontrast T1 or the T2 sequences, however may imply congestion orinflammation, uncertain etiology. Urine drug screen was obtained and negative. RPR negative. TSH WNL at 3.61. Vitamin D low at 18.6 and started on supplementation. COVID IgG Nonreactive, patient received Pfizer vaccine first dose 1 week prior to admission. Lumbar Puncture obtained on 4/11/21. CSF studies remarkable for elevated protein 45 with normal glucose and normal WBC 1. Multiple sclerosis panel sent on CSF fluid and pending. EBV panel, Mycoplasma serology, Cocci serology, EBV serology, ANA with reflex to Lupus panel, antiGQ1B, anti-GAD, Aquaporin 4, Anti MOG sent and pending.
CDC Split Type:

Write-up: Admitted to hospital on 4/10 with 2 day history of mydriasis, diplopia with blurry vision, dizziness and balance difficulty. Found to have enhancement of 6th and 3rd CNs on MRI. Patient continued to have blurry and double vision during her stay and mild gait instability. She developed mild frontal headache managed with Tylenol. Her exam was remarkable for mydriasis, mild lateral gaze limitation R$gL, mild dysmetria, dizziness and unsteady gait without notable ataxia. No papilledema. Her reflexes were 2+ in her BL UE and LEs. Pediatric Neurology and ophthalmology consulted and followed patient. Eye exam remarkable for bilateral cranial nerve 6 palsy but no other element of CN3 palsy and bilateral dilated but unreactive pupils. Patient treated with IVIG 1mg/kg/day x2 days for likely miller fisher syndrome variant of Guillain-Barre.


VAERS ID: 1215121 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-14
Onset:2021-04-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood creatine phosphokinase, Full blood count, Gait disturbance, Headache, Metabolic function test, Muscular weakness, Urine analysis
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Chronic lower back pain
Allergies: Egg whites
Diagnostic Lab Data: CBC, CMP, UA, CK - all performed 4/14/21 afternoon
CDC Split Type:

Write-up: 15 min after vaccine administration, pt experienced frontal headache, diffuse subjective weakness of LE, and gait instability. Admitted to medical center for monitoring and workup.


VAERS ID: 1219125 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: Unknown  
Vaccinated:2021-04-12
Onset:2021-04-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaphylactic reaction, Intensive care
SMQs:, Anaphylactic reaction (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypersensitivity (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: fluoxetine 20 mg tablet daily, spironolactone 25 mg tablet daily, metformin 1500 mg daily
Current Illness: No
Preexisting Conditions: PCOS, history of anaphylaxis to nuts and chocolate
Allergies: Peanuts, tree nuts, shellfish, and chocolate
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had anaphylaxis with recorded trigger (Pfizer COVID vaccine). She received epinephrine onsite, and then an additional dose of 0.3mg in ED. She however, required required two more doses of 0.5mg epinephrine and racemic epi neb. She was admitted for further observation given need for multiple doses of epinephrine. At approximately 9:00 am (~18 hours post vaccine) a rapid response was called on 4/13 and patient was transferred to the PICU for further treatment. Patient also received the last dose of epinephrine 0.5mg at approximately 9:00 am (~18 hours post vaccine). Patient received famotidine 20mg IV x1 and methylprednisolone 90mg IV x2 in the PICU. Patient was discharged on 4/14 at 8:00 am from the PICU, approximately 41 hours post vaccine administration. Received a total of epinephrine x7 doses during the hospitalization.


VAERS ID: 1221633 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-04-15
Onset:2021-04-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 AR / IM

Administered by: School       Purchased by: ?
Symptoms: Product administered to patient of inappropriate age
SMQs:, Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Sertraline - 75mg
Current Illness: unsure
Preexisting Conditions: Patient had developmental delays as a baby, toddler and preschooler. She also had significant hearing loss which, aside from affecting her ability to hear and therefore to focus well in preschool and early classroom settings, caused adverse effects on the development of her speech. Patient also has poor vision- her prescription/refraction increases (worsens) every 6 months. She also is diagnosed as probably having glaucoma because her pressures have been borderline for several years.
Allergies: unsure
Diagnostic Lab Data: unknown...Patient''s sister claimed in an email on Thurs 4/15 that Patient''s pediatrician, had been contacted and that the Dr was going to be "checking on what could be expected" - but nothing was shared with me after that Thurs 4pm email. All attempts to contact Patients Sister and Dad, Patient''s grandma- and my daughter, Patient have been to no avail. I''ve tried all phone numbers- by calling and leaving voice mails & by texting and ?''ve emailed. No response from any one of them. My own brother who claimed to be quite concerned yesterday Th 4/15 has not been in touch with any word on her status.
CDC Split Type:

Write-up: Patient is only 16 and the Moderna vaccine is only approved for those 18 and over. Her 23 year old sister, was forced by her father to take Patient with her to get the vaccine because Sister already had an appointment and it was "convenient" and less of a hassle for him. It is believed that they lied about Patient''s birth date because the forms (consent, registration, etc.) provided for the vaccine CLEARLY state the minimum age to receive the Moderna vaccine is 18. However, there should have been some accountability and proof of age should have been required (ie a birth certificate). It is believed that Patient is experiencing side effects, and that they may be serious. Her father and her sister, as well as her grandmother, (the court-mandated "Supervisor" for custody) refuse to provide me, Patient''s mom with any information regarding Patient''s well-being at this time- 1 1/2 days after the administration of the vaccine---and they have refused my attempts to contact them by simply not replying---which is unlike them. In the past, Patient has been hospitalized for several days and they did not advise me (again, this is against the court mandate.) It is not only illegal that Patient was vaccinated with the Moderna Covid 19 vaccine- and that Sister, Dad, and Grandma are liable (her grandma, knew in advance they were going to have the vaccine administered) but it is also illegal and unethical that my daughter may be quite unwell at this time and may be wanting and /or needing me and yet, I do not know where she is or how to get to her to help her. If she is okay, I want and deserve to know this information as well.


VAERS ID: 1225732 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-04-15
Onset:2021-04-16
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP7534 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN10162 / 2 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatinine normal, Blood urea normal, Chest pain, Fibrin D dimer increased, Haematocrit normal, Haemoglobin normal, Headache, Left ventricular dysfunction, Lymphocyte percentage decreased, Malaise, Monocyte percentage increased, Myalgia, Myocarditis, Neutrophil percentage increased, Platelet count normal, Pyrexia, SARS-CoV-2 test negative, Troponin I increased, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Haematopoietic leukopenia (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Immune-mediated/autoimmune disorders (broad), COVID-19 (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multivitamin, Vitamin B12, and vitamin D
Current Illness: Had transient nausea and emesis following consumption of rare-cooked meat in early February, otherwise was well
Preexisting Conditions: Anxiety, depression, vitamin deficiency
Allergies: None
Diagnostic Lab Data: 4/18/21: WBC 13, Hgb 15, Hct 44, Plt count 298. 73% neutrophils, 17% lymphocytes, 9% monocytes. BUN 14, Creatinine 1. Troponin I 1.58 ng/mL. D-dimer 0.91 microg/mL. SARS-coronavirus 2 PCR from NP sampling negative.
CDC Split Type:

Write-up: On 4/16/21, the day after receipt of the second SARS-CoV-2 vaccine the patient developed new headache, fever, malaise, and myalagias. on 4/17/21 the patient then developed chest pain which worsened over time and lead to diagnosis of myocarditis with decreased left ventricle function of 44-47% and with troponin I of 1.58 ng/mL.


VAERS ID: 1225942 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-19
Onset:2021-03-28
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH UNKNOWN / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiac arrest, Death, Laboratory test, Lung assist device therapy, Oral contraception, Pulmonary embolism, Resuscitation
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Arrhythmia related investigations, signs and symptoms (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Cardiomyopathy (broad), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-30
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Reported to be on Drospirenone-Ethinyl Estradiol 3-0.02 MG per tab
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient was a 16yr female who received Pfizer vaccine 3/19/21 at vaccine clinic and presented with ongoing CPR to the ED 3/28/21 after cardiac arrest at home. Patient placed on ECMO and imaging revealed bilateral large pulmonary embolism as likely etiology of arrest. Risk factors included oral contraceptive use. Labs have since confirmed absence of Factor V leiden or prothrombin gene mutation. Patient declared dead by neurologic criteria 3/30/21.


VAERS ID: 1227884 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-03-24
Onset:2021-03-29
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Basal ganglia infarction, Echocardiogram, Facial paralysis, International normalised ratio, Investigation, Ischaemic cerebral infarction, Magnetic resonance imaging, Motor dysfunction, SARS-CoV-2 test
SMQs:, Peripheral neuropathy (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Hearing impairment (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: SOTALOL; WARFARIN
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Arrhythmia; Cardiac valve prosthesis user; Implantable defibrillator insertion; Truncus arteriosus persistent
Allergies:
Diagnostic Lab Data: Test Date: 20210329; Test Name: TTE; Result Unstructured Data: Test Result:unchanged from prior; Test Date: 20210329; Test Name: INR; Result Unstructured Data: Test Result:2.68; Test Date: 20210329; Test Name: exam; Result Unstructured Data: Test Result:L sided motor deficits, L facial droop; Test Date: 20210329; Test Name: MRI; Result Unstructured Data: Test Result:Acute Infarct of R internal capsule and R basal ga; Comments: Acute Infarct of R internal capsule and R basal ganglia; Test Date: 20210329; Test Name: Covid-19 nasal swab test; Test Result: Negative ; Test Date: 20210330; Test Name: Covid-19 nasal swab test; Test Result: Negative
CDC Split Type: USPFIZER INC2021366410

Write-up: Acute Infarct of R internal capsule and R basal ganglia; Acute Infarct of R internal capsule and R basal ganglia; Left (L) sided motor deficits; L facial droop; This is a spontaneous report from a contactable physician. A 16-year-old female patient received bnt162b2 (PFIZER-BIONTECH COVID-19 VACCINE, solution for injection), dose 1 intramuscular, administered in left arm on 24Mar2021 (Batch/Lot number was not reported) as single dose for COVID-19 immunisation. Medical history included truncus arteriosus (status post (s/p) right ventricle-to-pulmonary artery (RV-PA) conduit and prosthetic aortic valve s/p automatic implantable cardioverter defibrillator (AICD) placement) and arrhythmias. The patient have no known allergies to medications, food, or other products. The patient was not diagnosed with COVID-19 prior to vaccination. The patient was not pregnant at the time of vaccination. Concomitant medications included sotalol taken for arrhythmias and warfarin. The patient was therapeutic on warfarin (INR 2.68) at admission and has been historically very compliant with medication. On 29Mar2021 14:00, the patient experienced acute infarct of right (R) internal capsule and R basal ganglia as diagnosed (dx) on magnetic resonance imagine (MRI), concerning for (C/f) cardio-embolic etiology in the setting of patient''s complex cardiac history. However, cannot rule out other causes of infarct. Left (L) sided motor deficits on exam, L facial droop. Transthoracic echocardiogram (TTE) was unchanged from prior. The patient was hospitalized for the events from 29Mar2021 to 05Apr2021. The patient underwent other lab tests and procedures which included COVID-19 nasal swab test was negative on 29Mar2021 and on 30Mar2021. Therapeutic measures were taken as a result of the events and included treatment with anticoagulation. Outcome of the events was recovered with sequel on 2021. The following information on the batch number has been requested.; Sender''s Comments: As there is limited information in the case provided, the causal association between the events and the suspect vaccine BNT162B2 cannot be excluded. Consider also possible contributory effects from patient''s pre-existing cardiac history. The case will be reassessed once new information is available. The impact of this report on the benefit/risk profile of the Pfizer drug is evaluated as part of Pfizer procedures for safety evaluation, including the review and analysis of aggregate data for adverse events. Any safety concern identified as part of this review, as well as any appropriate action in response, will be promptly notified to Regulatory Authorities, Ethics Committees and Investigators, as appropriate.


VAERS ID: 1229179 (history)  
Form: Version 2.0  
Age: 16.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-25
Onset:2021-04-15
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER2613 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Citrobacter infection, Culture urine positive, Hypotension, Hypothermia, Intensive care, Lethargy, Mental status changes, Sepsis
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Diazepam (sch), famotidine (sch), gabapentin (sch), MVI (sch),
Current Illness: none
Preexisting Conditions: Cerebral palsy, seizures, autism spectrum, constipation, reflux, non-verbal
Allergies: No known allergies
Diagnostic Lab Data: Urine culture positive for citrobacter 04/15/2021
CDC Split Type:

Write-up: lethary and altered mental status 2.5 weeks after COVID vaccine. Found to be septic (hypotension, hypothermia, suspected infection). Admitted to ICU. Required 15L vapotherm for respiratory support and several fluid boluses for blood pressure. Urine culture resulted positive for a bacterial infection. Started on antibiotics and improved. Concern for vaccine adverse event is low.


VAERS ID: 1231560 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-04-15
Onset:2021-04-17
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH ER 8731 / 2 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Electrocardiogram, Laboratory test, Myocarditis, Troponin increased, Ultrasound scan
SMQs:, Myocardial infarction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), 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? 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: PRESCRITPION: Sertraline 50mg tablets, Spironolactone 25mg tablets, Singulair 10mg tablets, Aurovela FE 1/20 tablets, Dexmethylphenidate ER 25mg, Cefdinir 300 mg caplets OTC: Lactaid Chewable Pill, Chewable Vitamin, Vitamin D (2000 IU,
Current Illness: Ear infection
Preexisting Conditions: ADHD, Anxiety
Allergies: Allergic to Persimmon fruit
Diagnostic Lab Data: Urgent Care Chest XRay (clear but showing distress) and EKG Hospital- EKG and Bloodwork (for Cardio) Other Hospital- Several tests were run (ultrasound, EKG, bloodwork) - diagnosis was myopericarditis. She was treated with high doses of NSAIDS and troponin levels began to drop from 7 to 6 to 5 to 3.5
CDC Split Type:

Write-up: On 4/17/21 (ie within 48 hours of receiving COVID 19 Pfizer Shot #2 (4/15/21), my daughter began experiencing chest pain in the PM (PM of 4/17). It was initially mild so we did a watch and wait overnight but when it did not go away by morning of 4/18/21 we went to Urgent Care . Upon presentation at urgent care, she had an irregular EKG, we were advised to immediately do to a Hospital ER , upon arrival she presented with same EKG findings from urgent care, BW was run and her troponin level was a 7, this hospital recommended (after consultation with their cardiologist) that based on her age and urgency of the heart condition, we should be transported to a pediatric hospital with cardiology expertise. She was transported by ambulance to another Hospital, Cardiology Unit. . After a scary 24 hour overnight stay at the hospital she was released on 4/19/21.


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https://medalerts.org/vaersdb/findfield.php?EVENTS=ON&PAGENO=3&VAX=COVID19&VAXTYPES=COVID-19&SERIOUS=ON&WhichAge=range&LOWAGE=(12)&HIGHAGE=(18)


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