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This is VAERS ID 1225942

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1225942
VAERS Form:2
Age:16.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-03-19
Onset:2021-03-28
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, Oral contraception, Pulmonary embolism, Resuscitation, Laboratory test, Lung assist device therapy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-30
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? 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.


Changed on 5/7/2021

VAERS ID: 1225942 Before After
VAERS Form:2
Age:16.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-03-19
Onset:2021-03-28
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, Oral contraception, Pulmonary embolism, Resuscitation, Laboratory test, Lung assist device therapy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-30
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? 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.


Changed on 5/14/2021

VAERS ID: 1225942 Before After
VAERS Form:2
Age:16.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-03-19
Onset:2021-03-28
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, Oral contraception, Pulmonary embolism, Resuscitation, Laboratory test, Lung assist device therapy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-30
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? 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.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1225942&WAYBACKHISTORY=ON

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