VAERS ID: 1420517

AGE: 65| SEX: M|STATE: CT (United States)

Description

1 week history of shortness of breath and nonproductive cough beginning shortly after receipt of second dose. Patient became hypoxic and had diffuse consolidation through left lung with wedge-shapes consolidation involving the right upper and midlateral lungs. Leukocytosis and bandemia noted and acute renal failure. Developed atrial fibrillation and rapid ventricular response. Multilobal pneumonia, septic shock, non-q-wave myocardial infarction, acute renal failure. Patient expired.

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Symptoms

Dyspnoea, Cough, Blood urea increased, Leukocytosis, Pneumonia, Hypoxia, Atrial fibrillation, Red blood cell count decreased, White blood cell count increased, Death, C-reactive protein increased, Septic shock, Acute myocardial infarction, Lung consolidation, Bandaemia, Acute kidney injury

Vaccines

VAX DATE: 05-27-2021| ONSET DATE: 05-29-2021| DAYS TO ONSET: 2
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 2 COVID19 MODERNA 041C21A IM LA

RECVDATE:06-23-2021
RPT_DATE:
CAGE_YR:65
CAGE_MO:
DIED:Y
DATEDIED:06-06-2021
L_THREAT:U
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:2
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:WBC = 10.4 at 14:35 6/5, 26.2 at 22:00 6/5, 30.9 at 06:40 6/6 RBC = 2.98, 2.8, 2.47 CRP = 19.9 at 14:35 6/5 BUN = 71, 66, 62
V_ADMINBY:PHM
OTHER_MEDS:
CUR_ILL:
HISTORY:chronic Hepatitis C Subarachnoid hemorrhage
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:06-23-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:Y
ALLERGIES:Penicillin
V_FUNDBY:

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