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VAERS Report 2136779

Case Report Section

Détails du rapport Vaer

Âge: 66 ans

Genre: Female

Région : Texas

Patient décédé?
Oui
Renseignements sur les vaccins

Nom: COVID19 (COVID19 (MODERNA))

Type : Coronavirus 2019 vaccine

Fabricant: MODERNA

Lot: 939676


Nom: COVID19 (COVID19 (MODERNA))

Type : Coronavirus 2019 vaccine

Fabricant: MODERNA

Lot: 033b21a


Date de réception du rapport
2022-02-24
Date à laquelle le formulaire est complèté
Date de vaccination
2021-07-01
Date d’apparition
223
Nombre de jours (date d’apparition – date de vaccination)
223
Description de l’événement indésirable

moderna covid vaccine eua: covid-19 case resulting in hospitalization / death. patient received moderna vaccine on 6/03/2021 and 7/01/2021. covid19 + 2/08/22. presented to ed 2/8/22 after 3-4 days of covid sxs w/increasing sob, wheezing and body aches. covid+. admitted for acute on chronic resp failure 2/2 hypoxia-multifactorial 2/2 covid pna and copd exacerbation. increased o2 demand from home o2 via nc. remained on nc overnight but was found to be off telemetry early the next morning. pt was slumped /pulseless, and code blue was called. intubated and regained pulse twice but then there was no further response. treated with decadron. expired 02/09/22

Données de laboratoire
2/08/22 this sample was analyzed using the roche liat sars assay platform using pcr or equivalent nucleic acid amplification (naa) technology
Liste des symptômes
malaise wheezing hypoxia pain condition aggravated dyspnoea cardio-respiratory arrest covid-19 sars-cov-2 test positive death pulse absent chronic obstructive pulmonary disease covid-19 pneumonia posture abnormal cardiac telemetry endotracheal intubation acute respiratory failure
Patient décédé?
Oui
Date de décès
2022-02-09
Anomalie congénitale
false
Vaccin administré par :
Pharmacy or store
Vaccin acheté par :
Inconnu
Visite d’un patient à l’urgence?
Non
Patient hospitalisé?
Oui
Séjour à l’hôpital
Non
Nombre de jours à l’hôpital
Non spécifié
Invalidité permanente?
Non
Allergies:
penicillins, benadryl, chocolate, red dye
Maladie actuelle
na