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Report #2824174

Received Feb 3, 2025

Died
A note on interpretation. VAERS reports are unverified and may be incomplete or coincidental. A report does not establish that a vaccine caused an event, and counts should not be used to calculate incidence or infer causation. Full disclaimer

Overview

Sex
Male
Age
97 yrs
State
MT
Recovered
Not recovered
Vaccinated
Feb 10, 2021
Onset
Oct 3, 2021
Days to onset
235
Hospital days
—

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA2031L20AIM / LA

Symptoms (14)

Acute myocardial infarctionAnuriaBlood glucose increasedBlood lactic acid increasedBlood pressure decreasedBreakthrough COVID-19DeathDecreased appetiteDyspnoeaHeart rate increasedHypoxiaRenal impairmentSARS-CoV-2 test positiveTroponin increased

Symptom narrative

Reported Symptoms: 10011906:DEATH; 10067923:VACCINE BREAKTHROUGH INFECTION; Narrative: patient living at home with wife and had four daughters as caretakers. Patient received two doses of Moderna COVID-19 vaccine (01/13/2021 & 02/10/2021). At presentation to emergency department (10/03/2021), patient had elevated heart rate, elevated blood sugars, appeared short of breath, not eating and requiring 6L of oxygen. COVID-19 test came back positive, along with elevated troponin, elevated lactate and worsening kidney function from baseline. Patient's kidney function did not support treatment with remdesivir, was was treated solely with dexamethasone. Patient's oxygen needs continued to escalate, blood pressure dropped, and was anuria throughout his stay in the hospital prior to expiring 10/05/2021. Other Relevant HX: Problem list significant for: CKD stage 4, T2DM, HTN, Troponin positive on admission for non-STMI Acute hypoxemia Other: COVID-19 Breakthrough Infection

Lab data

Positive COVID-19 test 10/03/2021