Adverse Event Reporting
| VAERS ID | 1030787 |
|---|---|
| Gender | Male |
| Age | 67 |
| StateCode | IL |
| Pharmaceutical Company | MODERNA |
| Lot Number | 010M20A |
| Number of vaccinations | 1 |
| Vaccinated | 2021-02-04 |
| Onset | 2021-02-06 |
| Condition | Died |
Symptoms
- Chest discomfort
- Nausea
- Retching
- Unresponsive to stimuli
- Bradycardia
- Acute myocardial infarction
- Echocardiogram abnormal
- Death
- Cardiac arrest
- Ventricular hypokinesia
- Resuscitation
- Cardiac pacemaker insertion
- Electrocardiogram ST segment elevation
- Ventricular fibrillation
- Pulseless electrical activity
- Atrioventricular block second degree
Current Illness
Preexisting Conditions
tubolovillous adenoma, chronic kidney disease, gout, hyperlipidemia, hx of kidney stone.
Other Medications
Allopurinol 300mg PO daily, Simvastatin 10mg qhs
Previous Vaccinations
Allergies
No known drug allergies
Laboratory Data
EKG (2/12/21) - Sinus rhythm with 2:1 conduction block and anterior ST elevation ECHO bedside (2/12/21) - 1.
LVEF< 10% with global diffuse severe hypokinesis - LV stand still.
Write-up
Pt admitted from home with intermittent nausea, dry heaving, and central chest pressure which self resolve in 2 minutes since 2/6/21.
Called 911 on 2/12/21 due to sustained episode that did not resolve.
EMS treated with aspirin and nitroglycerin prior to arrival to ED.
In ED patient became unresponsive and went into full cardiac arrest -CPR and ACLS care initiated.
STEMI with AV conduction block.
2nd degree a-v block type II - significant bradycardia - temoprary pacemaker placed - Vfib -PEA.
Time of death 0955 on 2/12/21 Patient recieved first dose of Moderna Covid vaccine on 2/4/21