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This is VAERS ID 1688944

History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1688944
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain, Chest X-ray abnormal, Chills, Cough, Death, Dyspnoea, Lung infiltration, Nausea, Nephropathy, Pyrexia, Tachycardia, Tachypnoea, General physical health deterioration, Nucleic acid test, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-08-28
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: carvedilol 12.5mg BID, Norco 5-325mg take 1 tab cont. q6h prn, Mag Ox 400mg BID, Cellcept 250mg 3 tabs in the morning and nightly, Nifedipine 60mg daily, omeprazole 40mg BID, prednisone 10mg daily, remipril 5mg nightly, Bactrim 400-80mg dai
Current Illness: Umbilical Hernia
Preexisting Conditions: CHF, HTN, Kidney Transplant s/p 15 years
Allergies: NKDA
Diagnostic Lab Data: COVID-19 Positive 8/14/21: This sample was analyzed using the Biofire Torch system using PCR or equivalent Nucleic Acid Amplification
CDC 'Split Type':

Write-up: Moderna COVID-19 Vaccine EUA: COVID-19 case resulting in Hospitalization / Death. Patient received Moderna Vaccine on 05/20/2021 and 06/17/2021. Presented to ED on 8/14 with complaints of shortness of breath and coughing. Noticed symptoms of chills, nausea, and abdominal pain on 8/11. In ED pt was febrile, tachycardic, and tachypneic. CXR showed bilateral infiltrates. Patient required HFNC at 75-90% and Non-rebreather. Patient was proned. During stay, patient received zosyn, vacomycin,prednisone, ceftriaxone, and decadron. Renal disease precluded use of remdesivir. Patient continued to decline and expired on 8/28/21.

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