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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1700329

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Case Details

VAERS ID: 1700329 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-07-23
Onset:2021-08-30
   Days after vaccination:38
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNAVAILABLE / 2 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Abdominal pain, Activated partial thromboplastin time prolonged, Acute kidney injury, Acute myocardial infarction, Acute respiratory failure, Alanine aminotransferase increased, Anisocytosis, Aspartate aminotransferase normal, Base excess abnormal, Basophil count, Basophil percentage decreased, Blood albumin decreased, Blood bicarbonate decreased, Blood calcium decreased, Blood chloride normal, Blood creatinine normal, Blood fibrinogen decreased, Blood glucose increased, Blood magnesium normal, Blood pH normal, Blood potassium normal, Blood sodium normal, Blood urea increased, Bronchoscopy abnormal, Calcium ionised decreased, Carbon dioxide abnormal, Carbon dioxide decreased, Cardiac arrest, Catheterisation cardiac abnormal, Chest X-ray abnormal, Coronary artery occlusion, Culture, Death, Dyspnoea, Electrocardiogram abnormal, Endotracheal intubation, Eosinophil count decreased, Eosinophil percentage decreased, Fatigue, Fibrin D dimer, Full blood count, Haematocrit decreased, Haemofiltration, Haemoglobin decreased, Haemorrhage, Hypoxia, Immature granulocyte count increased, Intensive care, International normalised ratio increased, Lung assist device therapy, Lung opacity, Lymphocyte count decreased, Lymphocyte percentage decreased, Mean cell haemoglobin concentration decreased, Mean cell haemoglobin normal, Mean cell volume increased, Mean platelet volume increased, Mechanical ventilation, Metabolic function test, Monocyte count, Monocyte percentage decreased, Myocardial infarction, Neutrophil count increased, Oxygen saturation decreased, PCO2 decreased, PO2 decreased, Platelet count decreased, Prothrombin time prolonged, Pulmonary alveolar haemorrhage, Pulmonary haemorrhage, Pyrexia, Red blood cell count decreased, Red blood cell nucleated morphology present, Red cell distribution width increased, Right ventricular failure, SARS-CoV-2 test negative, Sepsis, Septic shock, Sinus tachycardia, Tachycardia, Urine analysis normal, Vomiting, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Infective pneumonia (broad), Dehydration (broad), Sepsis (narrow), Opportunistic infections (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-09-15
   Days after onset: 16
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 15 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: ergocalciferol, vitamin D2, 50,000 Units capsule pimecrolimus cream (ELIDEL) 1 % cream triamcinolone ointment (KENALOG) 0.1 % ointment
Current Illness: Lupus
Preexisting Conditions: Lupus diagnosis on 7/21/21
Allergies: Bactrim
Diagnostic Lab Data: Results for patient 9/1/2021 04:10 Arterial pH: 7.35 Arterial pCO2: 31.5 (L) Arterial pO2: 71.6 Arterial HCO3: 16.8 (L) Arterial Total CO2: 17.8 (L) Arterial Base Excess/Deficit: -7.6 Arterial Measured O2 Saturation: 90.0 Sodium Blood: 136 Potassium Blood: 4.4 Chloride Blood: 114 (H) Carbon Dioxide: 17.8 (L) Glucose Blood: 241 (H) BUN: 27 (H) Creatinine Blood: 0.82 Calcium Blood: 6.8 (L) WBC: 11.3 (H) RBC: 2.33 (L) Hemoglobin: 7.2 (L) Hematocrit: 22.8 (L) MCV: 97.9 MCH: 30.9 MCHC: 31.6 (L) Platelet Count: 184 MPV: 11.4 (H) RDW: 17.9 (H) Nucleated RBC Automated: 0.2 (H) Differential Type: MANUAL DIFF % Seg: 97.5 (H) % Lymphocytes: 1.0 (L) % Monocytes: 1.0 % Meta: 0.5 (H) Absolute Neutrophils: 11.018 (H) Abs Seg: 11.02 (H) Absolute Lymphocytes: 0.11 (L) Absolute Monocytes: 0.11 Abs Meta: 0.06 (H) Total Cells Counted: 198 Anisocytosis: SLIGHT Results for patient 9/1/2021 13:38 Arterial pH: 7.11 (LL) Arterial pCO2: 62.6 (HH) Arterial pO2: 70.3 Arterial HCO3: 18.8 (L) Arterial Total CO2: 20.7 Arterial Base Excess/Deficit: -12.7 Arterial Measured O2 Saturation: 85.2 (L) Sodium Blood: 137 Potassium Blood: 4.7 Chloride Blood: 119 (H) Carbon Dioxide: 20.7 (L) Glucose Blood: 226 (H) BUN: 31 (H) Creatinine Blood: 0.89 Calcium Blood: 6.6 (L) WBC: 17.0 (H) RBC: 2.90 (L) Hemoglobin: 8.9 (L) Hematocrit: 28.7 (L) MCV: 99.0 MCH: 30.7 MCHC: 31.0 (L) Platelet Count: 187 MPV: 11.0 (H) RDW: 16.9 (H) Nucleated RBC Automated: 0.1 (H) Differential Type: AUTOMATED DIFF % Neutrophils: 94.1 (H) % Imm Gran: 1.2 (H) % Lymphocytes: 1.1 (L) % Monocytes: 3.2 % Eosinophils: 0.0 % Basophils: 0.4 Absolute Neutrophils: 15.930 (H) Abs Imm Gran: 0.21 (H) Absolute Lymphocytes: 0.19 (L) Absolute Monocytes: 0.55 (H) Absolute Eosinophils: 0.00 Absolute Basophils: 0.07 Results for patient 9/4/2021 16:04 Arterial pH: 7.40 Arterial pCO2: 47.4 (H) Arterial pO2: 60.2 (L) Arterial HCO3: 28.5 (H) Arterial Total CO2: 29.9 (H) Arterial Base Excess/Deficit: 3.7 Arterial Measured O2 Saturation: 89.7 (L) Sodium Blood: 146 (H) Potassium Blood: 3.0 (L) Chloride Blood: 106 Carbon Dioxide: 29.9 Glucose Blood: 176 (H) BUN: 67 (HH) Creatinine Blood: 2.53 (H) Calcium Blood: 8.3 (L) Ionized Calcium: 4.66 Magnesium Blood: 1.9 WBC: 8.7 RBC: 2.47 (L) Hemoglobin: 7.2 (L) Hematocrit: 21.9 (L) MCV: 88.7 MCH: 29.1 MCHC: 32.9 Platelet Count: 96 (L) MPV: 11.2 (H) RDW: 16.1 (H) Nucleated RBC Automated: 0.6 (H) Differential Type: AUTOMATED DIFF % Neutrophils: 93.0 (H) % Imm Gran: 1.6 (H) % Lymphocytes: 1.5 (L) % Monocytes: 3.7 % Eosinophils: 0.0 % Basophils: 0.2 Absolute Neutrophils: 8.120 (H) Abs Imm Gran: 0.14 (H) Absolute Lymphocytes: 0.13 (L) Absolute Monocytes: 0.32 Absolute Eosinophils: 0.00 Absolute Basophils: 0.02 PT Result: 16.1 (H) INR Result: 1.25 PTT Result: 94.3 (H) TT Result: $g100.0 (H) D Dimer: 2.56 (H) Fibrinogen: 192 (L) Heparin Level.: 0.36 PREOPERATIVE DIAGNOSIS: STEMI POSTOPERATIVE DIAGNOSIS: stemi Procedure(s): Left heart catheterization with coronary angiography JL3 and SCR ANESTHESIA: General ESTIMATED BLOOD LOSS: Minimal COMPLICATIONS: None CONDITION: Critical ACCESS: 5 Fr left FA FINDINGS: Totally occluded left anterior descending & circumflex coronary arteries. Right coronary artery patent
CDC Split Type:

Write-up: Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with Pulmonary hemorrhage. About 2 days ago, pt developed fevers and worsening shortness of breath. T max 102 F at home. He did not note anything that relieved or exacerbated his difficulty breathing. He also reported fatigue, abdominal pain and several episodes of NBNB emesis the week prior to admission. No recently chest pain, diarrhea, hematuria, dysuria, headache or neck stiffness. Pt presented to ED yesterday and was treated with antibiotics and discharged, he came back today due to worsening shortness of breath. Of note, pt was had 2 hospital admissions in the last 2 months, most recently for febrile neutropenia. Completed 2 doses of COVID vaccine. At ED, pt arrived with temp of 39.1, HR 143, RR 28, BP 117/67, SpO2 98% EKG with sinus tachycardia, no ST elevations/depressions or other acute ischemic changes. CXR revealed diffuse bilateral airspace opacities without pneumothorax. CBC 10.6$g8.1/27.4<203, CMP 137/3.9/110/22/18/0.58<99, Ca 7, Alb 1.5, AST 15, ALT 86. UA negative for infection, no protein. CXR with progressive diffuse bilateral airspace opacity with air bronchograms, no pneumothorax. Cultures obtained. Pt was treated with vancomycin, cefepime and levofloxacin for sepsis and concern for pneumonia and given IV fluids per ED sepsis protocol. He was also given Solumedrol 1g. Less likely COVID given vaccination status and negative COVID swab. Due to worsening tachycardia and hypoxia on oxygen, pt was intubated and bleeding in airway was noted. Pt was admitted to the ICU, and pulm crit care performed a bronchoscopy that revealed diffuse alveolar hemorrhage. Repeat CXR in ICU revealed almost complete white out of both lungs. Pt was bagged for almost an hour due to persistent hypoxia. Pt was subsequently transferred to CW due to concern for requiring VV ECMO. On arrival to CW CICU, pt satting low 70s, vent settings titrated and sats improved to 90s. He was continued on Epi, Norepi, Dexmed and Fentanyl. Rheum history: Lupus diagnosed on renal biopsy 7/21/21, on bactrim prophylaxis recently, recent treatment with rituximab, on daily prednisone 30 mg BID Parents spanish speaking. Patient is a 18 y.o. male patient with a past medical history significant for lupus who presents with acute hypoxic respiratory failure requiring mechanical ventilation, septic shock and pulmonary hemorrhage. It is unclear at this time if his pulmonary hemorrhage is related to lupus vs idiopathic process. COVID negative and fully vaccinated, making COVID pneumonia less likely. He is maintaining his MAPs on epinephrine and arterial sats in the 90s on SIMV PC PS. He is candidate for VV ECMO but does not require it at this time due to decreasing vent settings. Rheumatology consulted and large lab workup is underway. Plan to continue broad spectrum antibiotics, close monitoring of hemodynamics and to continue to watch for signs of recurrent pulmonary hemorrhage. Pt requires CICU due to risk of acute cardiopulmonary decompensation. Patient was an 18 yo man with Dx of lupus who presented to hospital (transferred from outside hospital) in respiratory failure due to pulmonary hemorrhage. Due to worsening hypoxemia in spite of mechanical ventilation he was started on VV ECMO. While on VV ECMO, he had a cardiac arrest due to right ventricular failure and was converted to VA ECMO. He also developed acute renal failure and was on CRRT. On 9/14, while on VA ECMO, he developed a massive MI due to occlusion of his LAD and circumflex coronaries. This heart injury was assessed as non recoverable and all further care was considered futile. After given time to the family to say their goodbyes, patient was removed from VA ECMO support and pronounced dead with his family at the bedside on 9/15/2021 at 7:30 am


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