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This is VAERS ID 1741118

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/1/2021

VAERS ID: 1741118
VAERS Form:2
Age:56.0
Sex:Male
Location:Tennessee
Vaccinated:2021-09-01
Onset:2021-09-24
Submitted:0000-00-00
Entered:2021-09-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 053E21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cryotherapy, Hypoxia, Leg amputation, Peripheral ischaemia, General physical health deterioration, Left ventricular dysfunction, Ejection fraction decreased, Deep vein thrombosis, Anticoagulant therapy, Echocardiogram abnormal, Acute kidney injury, COVID-19, Exposure to SARS-CoV-2

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-09-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Diabetes
Allergies: NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Admitted on 9/7/2021 with COVID-19 and sever hypoxia. Known COVID contact several days prior. Treated with remdesivir, dexamethasone, ceftriaxone, and azithromycin. Also started on barictnib on 9/9 but stopped due to ARF. Echocardiogram showed EF of 25-50% with moderately severe LV function. Started on heparin and continued throughout hospital stay. DVT in right lower leg. Seen by infectious disease and continued on cefepime and levofloxacin for 14 days. Underwent cryo-amputation of right ischemic lower extremity and then BKA by vascular surgery. Prognosis poor and not improving. Family elected comfort care.

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