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This is VAERS ID 1136945

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1136945
VAERS Form:2
Age:16.0
Sex:Male
Location:Wyoming
Vaccinated:2021-03-17
Onset:2021-03-22
Submitted:0000-00-00
Entered:2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 AR / SYR

Administered by: Private      Purchased by: ??
Symptoms: Atrioventricular block first degree, Biopsy heart abnormal, Cardiac arrest, Complement fixation test positive, Electrocardiogram abnormal, Heart sounds abnormal, Intensive care, Pain in extremity, Resuscitation, Transplant rejection, Echocardiogram abnormal, Cardiac dysfunction, Anti-HLA antibody test positive, Lung assist device therapy, SARS-CoV-2 test negative, SARS-CoV-2 antibody test

Life Threatening? Yes
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tacrolimus, Mycophenylate, Losartan, Vitamin D
Current Illness: none
Preexisting Conditions: heart transplant, limb-girdle muscular dystrophy, obesity
Allergies: none
Diagnostic Lab Data: Heart biopsy: 3/22/2021 Acute cellular and acute antibody-mediated rejection HLA testing: 3/22/2021 New donor specific antibody against donor heart Sars CoV PCR 3/22/2021 NEGATIVE Sars CoV Nucleocapsid IgG is pending
CDC 'Split Type':

Write-up: Sore arm on 3/20/2021. No other symptoms/signs. Presented for routine heart transplant follow up visit 3/22/2021 and was found to have new decreased cardiac function by echo, new 1st degree heart block by ECG, and new gallop. Patient taken to cath lab 3/22/2021 for biopsy and hemodynamic assessment, but he had V fib arrest with anesthesia induction. After initiation of CPR, patient was placed on ECMO. Biopsy shows ACR 2R (moderate cellular rejection) and pAMR 2 (moderate antibody-mediated rejection). Labs show new donor specific, complement-fixing Antibody against the cardiac allograft. Patient is in ICU being treated for acute rejection.


Changed on 5/7/2021

VAERS ID: 1136945 Before After
VAERS Form:2
Age:16.0
Sex:Male
Location:Wyoming
Vaccinated:2021-03-17
Onset:2021-03-22
Submitted:0000-00-00
Entered:2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 AR / SYR

Administered by: Private      Purchased by: ??
Symptoms: Atrioventricular block first degree, Biopsy heart abnormal, Cardiac arrest, Complement fixation test positive, Electrocardiogram abnormal, Heart sounds abnormal, Intensive care, Pain in extremity, Resuscitation, Transplant rejection, Echocardiogram abnormal, Cardiac dysfunction, Anti-HLA antibody test positive, Lung assist device therapy, SARS-CoV-2 test negative, SARS-CoV-2 antibody test

Life Threatening? Yes
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tacrolimus, Mycophenylate, Losartan, Vitamin D
Current Illness: none
Preexisting Conditions: heart transplant, limb-girdle muscular dystrophy, obesity
Allergies: none none
Diagnostic Lab Data: Heart biopsy: 3/22/2021 Acute cellular and acute antibody-mediated rejection HLA testing: 3/22/2021 New donor specific antibody against donor heart Sars CoV PCR 3/22/2021 NEGATIVE Sars CoV Nucleocapsid IgG is pending
CDC 'Split Type':

Write-up: Sore arm on 3/20/2021. No other symptoms/signs. Presented for routine heart transplant follow up visit 3/22/2021 and was found to have new decreased cardiac function by echo, new 1st degree heart block by ECG, and new gallop. Patient taken to cath lab 3/22/2021 for biopsy and hemodynamic assessment, but he had V fib arrest with anesthesia induction. After initiation of CPR, patient was placed on ECMO. Biopsy shows ACR 2R (moderate cellular rejection) and pAMR 2 (moderate antibody-mediated rejection). Labs show new donor specific, complement-fixing Antibody against the cardiac allograft. Patient is in ICU being treated for acute rejection.


Changed on 5/14/2021

VAERS ID: 1136945 Before After
VAERS Form:2
Age:16.0
Sex:Male
Location:Wyoming
Vaccinated:2021-03-17
Onset:2021-03-22
Submitted:0000-00-00
Entered:2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 AR / SYR

Administered by: Private      Purchased by: ??
Symptoms: Atrioventricular block first degree, Biopsy heart abnormal, Cardiac arrest, Complement fixation test positive, Electrocardiogram abnormal, Heart sounds abnormal, Intensive care, Pain in extremity, Resuscitation, Transplant rejection, Echocardiogram abnormal, Cardiac dysfunction, Anti-HLA antibody test positive, Lung assist device therapy, SARS-CoV-2 test negative, SARS-CoV-2 antibody test

Life Threatening? Yes
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tacrolimus, Mycophenylate, Losartan, Vitamin D
Current Illness: none
Preexisting Conditions: heart transplant, limb-girdle muscular dystrophy, obesity
Allergies: none none
Diagnostic Lab Data: Heart biopsy: 3/22/2021 Acute cellular and acute antibody-mediated rejection HLA testing: 3/22/2021 New donor specific antibody against donor heart Sars CoV PCR 3/22/2021 NEGATIVE Sars CoV Nucleocapsid IgG is pending
CDC 'Split Type':

Write-up: Sore arm on 3/20/2021. No other symptoms/signs. Presented for routine heart transplant follow up visit 3/22/2021 and was found to have new decreased cardiac function by echo, new 1st degree heart block by ECG, and new gallop. Patient taken to cath lab 3/22/2021 for biopsy and hemodynamic assessment, but he had V fib arrest with anesthesia induction. After initiation of CPR, patient was placed on ECMO. Biopsy shows ACR 2R (moderate cellular rejection) and pAMR 2 (moderate antibody-mediated rejection). Labs show new donor specific, complement-fixing Antibody against the cardiac allograft. Patient is in ICU being treated for acute rejection.


Changed on 6/4/2021

VAERS ID: 1136945 Before After
VAERS Form:2
Age:16.0
Sex:Male
Location:Wyoming
Vaccinated:2021-03-17
Onset:2021-03-22
Submitted:0000-00-00
Entered:2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6204 / 1 AR / SYR

Administered by: Private      Purchased by: ??
Symptoms: Atrioventricular block first degree, Biopsy heart abnormal, Cardiac arrest, Complement fixation test positive, Electrocardiogram abnormal, Heart sounds abnormal, Intensive care, Pain in extremity, Resuscitation, Transplant rejection, Echocardiogram abnormal, Cardiac dysfunction, Anti-HLA antibody test positive, Lung assist device therapy, SARS-CoV-2 test negative, SARS-CoV-2 antibody test

Life Threatening? Yes
Birth Defect? No
Died? No
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Tacrolimus, Mycophenylate, Losartan, Vitamin D
Current Illness: none
Preexisting Conditions: heart transplant, limb-girdle muscular dystrophy, obesity
Allergies: none
Diagnostic Lab Data: Heart biopsy: 3/22/2021 Acute cellular and acute antibody-mediated rejection HLA testing: 3/22/2021 New donor specific antibody against donor heart Sars CoV PCR 3/22/2021 NEGATIVE Sars CoV Nucleocapsid IgG is pending
CDC 'Split Type':

Write-up: Sore arm on 3/20/2021. No other symptoms/signs. Presented for routine heart transplant follow up visit 3/22/2021 and was found to have new decreased cardiac function by echo, new 1st degree heart block by ECG, and new gallop. Patient taken to cath lab 3/22/2021 for biopsy and hemodynamic assessment, but he had V fib arrest with anesthesia induction. After initiation of CPR, patient was placed on ECMO. Biopsy shows ACR 2R (moderate cellular rejection) and pAMR 2 (moderate antibody-mediated rejection). Labs show new donor specific, complement-fixing Antibody against the cardiac allograft. Patient is in ICU being treated for acute rejection.

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