Adverse Event Reporting
| VAERS ID | 1736717 |
|---|---|
| Gender | Male |
| Age | 75 |
| StateCode | TX |
| Pharmaceutical Company | MODERNA |
| Lot Number | 007M20A |
| Number of vaccinations | 2 |
| Vaccinated | 2021-01-30 |
| Onset | 2021-09-15 |
| Condition | Hospitalized Died |
Symptoms
- Dyspnoea
- Chest X-ray abnormal
- SARS-CoV-2 test positive
- COVID-19 pneumonia
- Death
- Hypoxia
- Lung infiltration
- Positive airway pressure therapy
Current Illness
Preexisting Conditions
Atrial fibrillation, Barrett's esophagus, peptic ulcer disease, chronic heart failure, dyslipidemia, hypertension
Other Medications
Diltiazem 30 mg three times daily, apixaban 5 mg twice daily, ezetimbe 10 mg daily, xopenex 2 puffs every 6 hours as needed, lutein 10 mg daily, metoprolol 25 mg as needed, omega-3 fatty acids-fish oil (FISH OIL) 300-1,000 mg Capsule once d
Previous Vaccinations
Allergies
No known allergies
Laboratory Data
COVID Positive on 9/15/2021; Chest X-ray revealed worsening diffuse bilateral pulmonary infiltrates on 9/15/2021
Write-up
MODERNA COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death.
Patient received Moderna Vaccines on 1/2/2021 and 1/30/2021.
Patient previously hospitalized for for COVID pneumonia 8/26/2021 to 8/31/2021.
Patient presented to ED on 9/9/2021 for shortness of breath.
Patient was placed on BiPAP for worsening hypoxia.
Patient received: methylprednisolone, zosyn, and vancomycin.
Respiratory condition worsened and family decided to place patient on comfort care.
Patient expired shortly after at 0953 on 9/16/2021.