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This is VAERS ID 1218081

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1218081
VAERS Form:2
Age:17.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-04-02
Onset:2021-04-10
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0150 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Apnoeic attack, Blood culture positive, Chest pain, CSF culture positive, Culture urine positive, Death, Dyspnoea, Renal dysplasia, Respiratory arrest, Resuscitation, Syncope, Escherichia bacteraemia, Pulseless electrical activity, Enterococcal infection, Pulmonary artery occlusion, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: see previous report history of spina bifida, high lumbar myelomenigocele status post repair, ventriculoperitoneal shunt and associate neurogenic bladder requiring self catheterization, neurogenic bowel and non mobile lower extremities.
Allergies: see previous report
Diagnostic Lab Data: COVID-19 nasopharyngeal swab: negative Urine cultures (prelim): Escherichia coli and Enterococcus faecalis CSF cultures (prelim) E. faecalis, Streptococcus species, E. coli Blood cultures (prelim) Staphylococcus species Right lung cultures (prelim) gram-positive cocci in chains Left lung cultures (prelim) young microbial growth Respiratory Possible pulmonary emboli; histologic examination pending- near complete to complete occlusion of right upper pulmonary artery. Partial occlusion of left upper pulmonary artery. Possible dilated vasculature and airways at peripheral pleura in left lung, pending histologic examination Genitourinary small dysplastic right kidney lobulated left kidney, pending histologic examination Hematolymphoid: splenomegaly: 220g No other overt gross abnormalities, pending histologic examination
CDC 'Split Type':

Write-up: From Post mortem report from Hospital: when on 4/10/21, she was in the process of self catheterization and began experiencing difficulty breathing and chest pain. Shortly after she collapsed and was not breathing. EMS arrived and found her apneic and in pulseless electrical activity. Resuscitation began and continued upon arrival to the ED. Aside from a short period of returned pulses, she remained in PEA despite an estimated 45-50 minutes of resuscitation. She died at 11:20am on 4/10/21. - Directly from Pathology report 4.12.21


Record is removed as of 4/30/2021

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