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This is VAERS ID 1753893

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First Appeared on 10/8/2021

VAERS ID: 1753893
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 002F21A / 1 - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dyspnoea, Pulmonary embolism, Vena cava filter insertion, Anticoagulant therapy, Computerised tomogram thorax abnormal, Mechanical ventilation, Endotracheal intubation, Multiple organ dysfunction syndrome, Positive airway pressure therapy

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-09-29
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? Yes, days: 24     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Humira Prednisone
Current Illness:
Preexisting Conditions: Diabetic Rheumatoid Arthritis
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 10 days after receiving the first dose of Moderna, patient presented at the ER with difficulty breathing. CT revealed bi-lateral pulmonary embolisms. A few days on anti-coagulants and was released. She returned a couple days later with worsening breathing. Patient received bi-pap oxygen then underwent procedure to place filter to prevent blood clots from traveling. Patient was intubated and placed on mechanical ventilation and diagnosed with multiple system organ failure. Patient succumbed to the vaccine injury September 29, 2021.

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