VAERS ID: 1000874

AGE: 84| SEX: F|STATE: OH (United States)

Description

Pericarditis Tamponade. She went to the hospital with chest discomfort on the 25th and by the evening of the 26th had pericarditis to a degree that required a Pericardial Window emergency procedure. Prior to the vaccine, she was doing great with no issues. She was put on a ventilator and came through the procedure on the 27th. She was moved to rehab on February 1st, which is where she remains as of this submission.

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Symptoms

Pericarditis, Condition aggravated, Chest discomfort, Mechanical ventilation, Cardiac tamponade, Pathology test, Pericardial excision

Vaccines

VAX DATE: 01-21-2021| ONSET DATE: 01-24-2021| DAYS TO ONSET: 3
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 039K20A SYR Unknown

RECVDATE:02-04-2021
RPT_DATE:
CAGE_YR:84
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:Y
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:7
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:We are still waiting on final pathology but the Hospitalist recommended we submit this information. Her cardiologist was reviewing if there are similar potential responses to the vaccine as well, but since it is so new had yet to find a similar issue.
V_ADMINBY:PUB
OTHER_MEDS:Metoprolol, Lisinopril, Plavix, Pepcid, baby aspirin, daily vitamin, vitamin D
CUR_ILL:No
HISTORY:Had a heart attack and stent in Sept 2020. Prior to that, no health issues.
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:02-04-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:No
V_FUNDBY:

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