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VAERS Report 2136988

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: 939909


Nom: COVID19 (COVID19 (MODERNA))

Type : Coronavirus 2019 vaccine

Fabricant: MODERNA

Lot: 012m20a


Nom: COVID19 (COVID19 (MODERNA))

Type : Coronavirus 2019 vaccine

Fabricant: MODERNA

Lot: 032m20a


Date de réception du rapport
2022-02-24
Date à laquelle le formulaire est complèté
Date de vaccination
2021-11-27
Date d’apparition
76
Nombre de jours (date d’apparition – date de vaccination)
76
Description de l’événement indésirable

pfizer covid vaccine eua: covid-19 case resulting in hospitalization / death. patient received pfizer vaccine on 2/03/21, 3/03/2021 and 11/27/2021. covid19 + 2/07/22. presented to ed 2/11/22 c/o generalized weakness fever, back pain and leg pain both legs worse on the r leg with swelling and redness on the r leg as well, denies any trauma to the legs, she had a fever at home. admitted covid infx, r leg pain and abnormaol troponin.. cxr w/some left basal opacity. in the er bp 151/84 with pulse of 111, the last pulse rate prior to the event was 94. inr was 1.2. due to increasing swelling on the leg stat ct requested w/dic labs. at the same time started having ams, taken for stat brain ct. on arrival back to floor patient was unresponsive and code blue was initiated, treated with rocephin and steroids. pt expired 02/11/22

Données de laboratoire
2/07/22 this sample was analyzed using the sars assay platform using pcr or equivalent nucleic acid amplification(naa)technology
Liste des symptômes
troponin abnormal back pain unresponsive to stimuli pain in extremity erythema asthenia pyrexia chest x-ray abnormal laboratory test cardio-respiratory arrest covid-19 inappropriate schedule of product administration computerised tomogram sars-cov-2 test positive lung opacity mental status changes death computerised tomogram head peripheral swelling international normalised ratio increased
Patient décédé?
Oui
Date de décès
2022-02-11
Anomalie congénitale
false
Vaccin administré par :
Private
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:
na
Maladie actuelle
na