| VAERS ID: |
2148498 (history) |
| Form: |
Version 2.0 |
| Age: |
14.0 |
| Sex: |
Male |
| Location: |
New Jersey |
| Vaccinated: | 2022-02-24 |
| Onset: | 2022-02-25 |
| Days after vaccination: | 1 |
| Submitted: |
0000-00-00 |
| Entered: |
2022-02-28 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
FK9895 / UNK |
UN / IM |
Administered by: Private Purchased by: ?
Symptoms: Brain death,
Brain scan abnormal,
Computerised tomogram head abnormal,
Craniectomy,
Death,
Haematoma evacuation,
Intra-cerebral aneurysm operation,
Mechanical ventilation,
Ruptured cerebral aneurysm
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Respiratory failure (broad)
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 2022-02-27
Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None prior known
Preexisting Conditions: None prior known
Allergies: Eggs or Egg-derived Products (Chicken-derived Products)
Diagnostic Lab Data: CT of head 02/25/2022 Emergency Left Hemi-craniectomy with clipping of aneurysm and evacuation of hematoma 02/25/2022 Brain Death Evaluation 02/26/2022 with nuclear medicine brain scan Withdrawal of Ventilator Support 02/27/2022
CDC Split Type:
Write-up: Ruptured Cerebral Aneurysm Left Middle Cerebral Artery Circulation (02/25/2022) leading to death (02/27/2022) |
