Adverse Event Reporting
| VAERS ID | 1920867 |
|---|---|
| Gender | Male |
| Age | 63 |
| StateCode | |
| Pharmaceutical Company | MODERNA |
| Lot Number | 006C21A |
| Number of vaccinations | |
| Vaccinated | 2021-06-25 |
| Onset | 2021-09-09 |
| Condition | Hospitalized Died |
Symptoms
- Pyrexia
- Dyspnoea
- Intensive care
- Asthenia
- Hypotension
- SARS-CoV-2 test positive
- COVID-19
- Endotracheal intubation
- Death
- Hypoxia
- Cardiac arrest
- Shock
- Resuscitation
- Endotracheal intubation complication
- Tracheostomy
- Positive airway pressure therapy
- Tracheostomy tube removal
Current Illness
Preexisting Conditions
Other Medications
Previous Vaccinations
Allergies
Laboratory Data
Write-up
pt to ED after being diagnosed positive for COVID; x 3 days worsening SOB, generalized weakness; PMH: positive for sarcoidosis of lung and GERD; supplemental O2 given; hypoxemia worsened requiring BiPAP; transferred to ICU; intubated; tracheostomy later done but pt began to have fever and hypotension; tracheostomy leak suspected and tracheostomy was removed; reintubated; pt's condition continued to decline; worsening shock; experienced cardiac arrest and unable to be resuscitated; pt died in the hosp