| Days after vaccination:||2
|Vaccination / Manufacturer
||Lot / Dose
||Site / Route|
|COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA
||007M20A / 1
||LA / IM
Administered by: Other Purchased by: ?
Symptoms: COVID-19 pneumonia,
SMQs:, Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)
Life Threatening? No
Birth Defect? No
Date died: 2021-03-03
Days after onset: 19
Permanent Disability? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Other Medications: Patient Medication List: tacrolimus, mycophenolic acid, prednisone, clonidine, coumadin, vascepa, carbamazepine, vitamin d3, hydroxyzine, nifedipine, carvedilol, rosuvastatin, sodium bicarb, pioglitazone, lantus, humalog, lisinopril.
Current Illness: Dehydration 2 days prior, treatted by Hospital
Preexisting Conditions: Kidney failure and resulting transplant, IDDM, hyperlipidemia, Htn
Allergies: Seasonal allergies only
Diagnostic Lab Data: See medical records for details.
CDC Split Type:
Write-up: The patient became ill two days after the vaccination, and was hospitalized. He was diagnosed with COVID pneumonia on the 15th, and subsequently died.