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This is VAERS ID 1498080

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/30/2021

VAERS ID: 1498080
VAERS Form:2
Age:15.0
Sex:Male
Location:New York
Vaccinated:2021-07-18
Onset:2021-07-22
Submitted:0000-00-00
Entered:2021-07-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0198 / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Resuscitation, Syncope, Ventricular tachycardia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-07-22
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lopressor 25mg BID
Current Illness: Diagnosed May 2021 hypertrophic cardiomyopathy
Preexisting Conditions: Diagnosed May 2021 hypertrophic cardiomyopathy
Allergies: unknown
Diagnostic Lab Data: none at this time
CDC 'Split Type':

Write-up: 7/22/2021 Child collapsed on soccer field while playing soccer at a local camp. CPR was initiated immediately. EMS arrived and found patient in vtac. Shock x 5. ACLS, intubation attempted. Transported to Medical Center. Patient had covid in April 2021. Dx in May 2021 hypertrophic cardiomyopathy. Started on lopressor 25mg BID. Patient had reported to parents that he had not recently taken his medications. Patient had his second covid vaccine on Sunday 7/18/2021.

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