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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1454878

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Case Details

VAERS ID: 1454878 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: South Dakota  
Vaccinated:2021-01-19
Onset:2021-06-08
   Days after vaccination:140
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 LA / SYR
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0142 / 2 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Atrial fibrillation, COVID-19, COVID-19 pneumonia, Chills, Continuous positive airway pressure, Death, Dialysis, Endotracheal intubation, Fraction of inspired oxygen, Hypotension, Hypoxia, Intensive care, Lung opacity, Pyrexia, Respiratory failure, SARS-CoV-2 test positive
SMQs:, Acute renal failure (narrow), Anaphylactic reaction (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-06-23
   Days after onset: 15
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Hypertension; Type 2 diabetes, Obesity hypoventilation syndrome; previous history of traumatic brain injury (TBI); end-stage renal disease, chronic congestive heart failure, hemodialysis
Allergies: LEVOFLOXACIN; PIOGLITAZONE
Diagnostic Lab Data: Patient tested positive for COVID-19 on 06/08/2021 despite being fully vaccinated against it.
CDC Split Type:

Write-up: 65-year-old with history of TBI and end-stage renal disease subsequently initially admitted to the floor secondary to fever and chills. Found to have COVID-19 pneumonia. On June 13 a rapid response was called for worsening respiratory failure. Subsequently transferred to ICU. Initially on CPAP at 100% FiO2. CTA negative for PE but did show diffuse ground glass infiltrates. Completed 10 days of dexamethasone. Not a candidate for remdesivir given end-stage renal disease. Additionally on cefepime and Rocephin for 10 days subsequently restarted on meropenem. Fortunately patient continued to have hypoxemia unresponsive to noninvasive ventilation. He was intubated on June 19. At the time of intubation he expresses desire not to be intubated for an extended period of time. Unfortunately they are unable to wean from ventilator. Remains on 100% FiO2 with PEEP of 18 and was on nitric oxide. In addition was on paralytics. Remained on prednisone taper off of dexamethasone. In addition to above patient had complications A. fib with RVR further complicated by hypotension. Was on 3 pressors. Suspect multifactorial to sedation and patient with severe Covid who also has end-stage renal disease. SLED initiated while in-house. On the afternoon of June 23 palliative team did meet with patient''s siblings. That time determined to transition to comfort care. Compassionate extubation performed. Patient passed away shortly after extubation. Patient died of COVID-19 despite being fully vaccinated against it. Death Certificate Information: Part I: Cause of Death A. Respiratory Failure B. Pneumonia C. COVID-19 Part II Other Significant Conditions: Hypertension, Diabetes Mellitus Type 2, End Stage Renal Disease


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