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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1700095



Case Details

VAERS ID: 1700095 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-19
Onset:2021-09-14
   Days after vaccination:207
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 030L20A / 1 UN / IM
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 2 UN / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Acute myocardial infarction, Acute respiratory failure, Anxiety, Asthenia, Azotaemia, Brain natriuretic peptide increased, COVID-19, COVID-19 pneumonia, Cough, Dyspnoea, Hyperglycaemia, Hypophagia, Lactic acidosis, Myalgia, Patient isolation, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive, Sepsis, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Anaphylactic reaction (broad), Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), 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), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: melanoma status post excision in 2015
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: 72-year-old male with past medical history of melanoma status post excision in 2015 and hypertension presented to the emergency department complaints of shortness of breath. Patient reports that he was usual state of health until approximately 1.5 weeks ago when he started noticing some shortness of breath along with cough. Patient reports that he got fully vaccinated with Moderna against COVID-19 on February 19, 2021. Patient reports that his symptoms were worrisome therefore, couple of days later, he got tested positive for COVID-19. Patient reports that he initially isolated and had only mild cough with congestion however, his symptoms continued to worsen. Tested positive on 9/14/2021 72-year-old male with past medical history of melanoma status post excision in 2015 and hypertension presented to the emergency department complaints of shortness of breath. Patient reports that he was usual state of health until approximately 1.5 weeks ago when he started noticing some shortness of breath along with cough. Patient reports that he got fully vaccinated with Moderna against COVID-19 on February 19, 2021. Patient reports that his symptoms were worrisome therefore, couple of days later, he got tested positive for COVID-19. Patient reports that he initially isolated and had only mild cough with congestion however, his symptoms continued to worsen. Patient has had multiple episodes of pneumonia in the past. He tried to wait as he thought his symptoms would improve. Went to get regeneron 4 days ago. Patient reports that his symptoms continued to worsen and he has had multiple episodes of fevers/chills along with cough and congestion. Also has had muscle aches and weakness. Has had very poor oral intake. He was not improving therefore, his daughter convinced him to come to the emergency department for further evaluation. Upon arrival to the emergency department, patient was found to have acute hypoxemic respiratory failure secondary to sepsis in the setting of COVID 19 pneumonia and possible superimposed bacterial pneumonia, hyperglycemia, uremia, acute renal failure, elevated troponin/type 2 MI, elevated BNP, and lactic acidosis.


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