VAERS ID: 1152759

AGE: 48| SEX: F|STATE: NE (United States)

Description

7 AM 3/25/2021 - Patient called out to husband from the bathroom where she experienced a syncopal event, then passed out. An ambulance was called and she was revived for a short period of time. She was taken to Hospital where she coded 3 times. She was then life-flighted to second Hospital. According to the hospital records, tests conducted over the course of several days determined that she had no neurological activity. Initial reports in the records indicate pulmonary embolism, cardiac and respiratory arrest. She was on life support for the remainder of her time. Organ donation is being pursued at present and results of this are pending at time of this report submission. Date of death is unknown until organ retrieval is accomplished. Family will be contacted in the next few days to ask further questions about any other kinds of vaccine-related reactions that may have happened more immediately to days after the vaccination on 3/17/2021. A co-worker thought that she had shortness of breath for 3-4 days before this critical event occurred on 3/25/2021.

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Symptoms

Electroencephalogram abnormal, Syncope, Dyspnoea, Alanine aminotransferase increased, Aspartate aminotransferase increased, Right ventricular failure, Hypoxia, Pulmonary embolism, Echocardiogram, Brain injury, Chest X-ray abnormal, Loss of consciousness, Blood potassium decreased, Death, Cardio-respiratory arrest, Endotracheal intubation, Ultrasound Doppler abnormal, Angiogram, Fibrin D dimer increased, Life support, Angiogram abnormal, Computerised tomogram head normal, Liver function test increased, Right ventricular dilatation, Magnetic resonance imaging head abnormal, Right ventricular ejection fraction decreased

Vaccines

VAX DATE: 03-17-2021| ONSET DATE: 03-25-2021| DAYS TO ONSET: 8
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 045A21A IM LA

RECVDATE:03-31-2021
RPT_DATE:
CAGE_YR:48
CAGE_MO:
DIED:Y
DATEDIED:
L_THREAT:Y
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:Events on 3/25/2021: -AP Chest X-Ray, CT angiography proved bilateral pulmonary emboli, TTE showed severely dilated right ventricle with reduced EF at 60-65%. Arterial line and IJ central line placed for pressor support. Intubated on a vent. -Labs collected on this date: D_Dimer elevated at 5000, Potassium at 2.7, elevated LFT's - AST = 439, ALT = 331. -Vasc doppler venous bilateral lower extremities showed no evidence of DVT in either leg. Venous flows in bilateral lower legs showed high pressure indicating right sided heart failure. -CT of head w/o contrast negative for intracranial hemorrhage, hydrocephalus, mass, or midline shift. Calvarium is intact. -MRI Brain w/o contrast negative for acute intracranial abnormalities. Event on 3/26/2021: EEG concerning for myoclonic seizures related to anoxic brain injury Event on 3/28/2021: MRI Brain w/o contrast showed new changes suggesting hypoxic/anoxic injury
V_ADMINBY:PUB
OTHER_MEDS:unknown at this time
CUR_ILL:unknown at this time
HISTORY:unknown at this time
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:03-31-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:Y
ALLERGIES:unknown at this time
V_FUNDBY:

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