Adverse Event Reporting
| VAERS ID | 921572 |
|---|---|
| Gender | Male |
| Age | 87 |
| StateCode | WI |
| Pharmaceutical Company | MODERNA |
| Lot Number | |
| Number of vaccinations | 1 |
| Vaccinated | 2020-12-29 |
| Onset | 2020-12-30 |
| Condition | Died |
Symptoms
- Chills
- Pain
- Unresponsive to stimuli
- Fall
- Oxygen saturation decreased
- Death
- Hip fracture
Current Illness
Heart Failure
Preexisting Conditions
Chronic Kidney Disease, Atherosclerotic Heart Disease
Other Medications
Fluticasone, Lasix, Omeprazole, Sucarafate, Ropinrole HCl
Previous Vaccinations
Allergies
Lisinopril, Losartan
Laboratory Data
Write-up
Resident had body aches, a low O2 sat and had chills starting on 12/30/20.
He had stated that they had slightly improved.
On 1/1/21 he sustained a fall with a diagnosis of a displaced hip fracture.
On 1/2/21 during the NOC shift his O2 sat dropped again.
He later went unresponsive and passed away.