Adverse Event Reporting
| VAERS ID | 1068901 |
|---|---|
| Gender | Female |
| Age | 67 |
| StateCode | NH |
| Pharmaceutical Company | MODERNA |
| Lot Number | |
| Number of vaccinations | |
| Vaccinated | 2021-01-30 |
| Onset | 2021-02-21 |
| Condition | Died |
Symptoms
- Fatigue
- Electrocardiogram normal
- Chest pain
- Computerised tomogram normal
- Syncope
- Laboratory test
- Pain in jaw
- Electrocardiogram
- Computerised tomogram
- Respiratory arrest
- Cardioversion
- Red blood cell sedimentation rate normal
- Echocardiogram
- Inflammation
- Pulse absent
- Death
- Aortic dissection
- Aortitis
- Arteritis coronary
Current Illness
COVID prior to vaccination - still having symptoms SOB, Tired, foggy head -thinking
Preexisting Conditions
GCA Arthritis
Other Medications
Prednisone BP medication
Previous Vaccinations
Allergies
Laboratory Data
2/17-2/19 hospital admit Medical Center Labs, CT, Echo 2/21 EMTs conducted EKGs
Write-up
ER admit for CP and Jaw pain, exhaustion, Aortic arteritis normal SED rate found on CT scan hospital admit IV medications required Solumedrol and Actemra questionable how much medications received d/t IV's not working.
Released from care on 2/19 with prednisone .
Symptoms still present off and on.
2/21 922pm CP Jaw Pain severe EMT's called EKG done reported no heart attack, pain better, EMTs left.
10/15 severe Pain collapsed with no pulse and no breathing, EMTs returned unable to obtain a shock-able rhythm time of death pronounced.
reason for death on certificate Aortitis - hospitalist thinks aortic dissection d/t severe inflammation