National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1274722

History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1274722
VAERS Form:2
Age:45.0
Sex:Male
Location:Unknown
Vaccinated:2021-04-20
Onset:2021-04-28
Submitted:0000-00-00
Entered:2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest, Cardio-respiratory arrest, Death, Echocardiogram normal, Hyperkalaemia, Renal artery thrombosis, Renal failure, Ultrasound Doppler abnormal, Haematology test, Anticoagulant therapy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-30
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: none
Preexisting Conditions: none
Allergies: n/a
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt presented to the hospital after a cardiac arrest. Work up showed renal artery thrombosis b/l causing renal failure and hyperkalemia. ROSC was achieved and pt coded multiple times after. We were unable to obtain CT A 2/2 to pt being unstable so only U/S imaging with doppler was used for diagnosis. Pt was treated with heparin gtt., hematology work up was sent but cause not identified. ECHO did not show thrombosis in the heart. CCRT was attempted but pt expired.


Changed on 5/14/2021

VAERS ID: 1274722 Before After
VAERS Form:2
Age:45.0
Sex:Male
Location:Unknown
Vaccinated:2021-04-20
Onset:2021-04-28
Submitted:0000-00-00
Entered:2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest, Cardio-respiratory arrest, Death, Echocardiogram normal, Hyperkalaemia, Renal artery thrombosis, Renal failure, Ultrasound Doppler abnormal, Haematology test, Anticoagulant therapy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-30
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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: none
Preexisting Conditions: none
Allergies: n/a n/a
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt presented to the hospital after a cardiac arrest. Work up showed renal artery thrombosis b/l causing renal failure and hyperkalemia. ROSC was achieved and pt coded multiple times after. We were unable to obtain CT A 2/2 to pt being unstable so only U/S imaging with doppler was used for diagnosis. Pt was treated with heparin gtt., hematology work up was sent but cause not identified. ECHO did not show thrombosis in the heart. CCRT was attempted but pt expired.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1274722&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166