Report #2855346

Received Aug 23, 2025

HospitalizedER / ED visitOffice visitDisabled

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: Female
Age: 84 yrs
State: KY
Recovered: Not recovered
Vaccinated: Feb 12, 2021
Onset: May 3, 2021
Days to onset: 80
Hospital days: 17

Vaccines (4)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	006M20A	IM / LA
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	2	001B21A	IM / LA
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	006M20A	IM / LA
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	2	001B21A	IM / LA

Symptoms (22)

Acute left ventricular failureAstheniaAtrial fibrillationBreast cancer stage IVCardiac ablationCardiac monitoringCardiac resynchronisation therapyChest X-ray normalChest wall massCoughDepressionDyspnoea exertionalEjection fraction decreasedFallFatigueLead dislodgementMass excisionOedema peripheralRespiratory tract congestionSARS-CoV-2 test negativeSkin lacerationTriple negative breast cancer

Symptom narrative

5/3/2021 - Saw patient for diagnosed dyspenea on exertion. Rx for 5 mg Lisinopril. 7/24/2021 - Urgent care for fatigue. cough, and congestion. 7/30/21 - Urgent care for fatigue. cough, and congestion. 8/19/2021 - Increase Rx for depression. 2/1/2022 - Ejection fraction still low, so Cardiology Referral. 2/18/2022 - Dr. at hospital. Acute systolic CHF and 1 year fatigue. Rx for Toprol 25 mg. 3/16/2022 - Fall with head split open. ER noted patient was in AFIB. May 2022 - Patient had a heart monitor installed. Dr. at hospital. 8/28/2023 - Biventricular PPM and AV node ablation. Pacemaker installed. 3/11/2024 - 3/18/2024 - Hospital pacemaker upgrade to biventricular CRT on 3/15/2024. Hospital inpatient stay. Low energy and fatigue. 3/25/2024 - 3/26/2024 - Dislodged pacemaker lead extracted and replaced. Hospital inpatient stay. 4/25/2024 - 4/27/2024 - Hospitalization for heart medication changes since still low energy and fatigued. 5/7/2024 - 5/13/2024 - Hospitalization for procedures and heart medication changes since still low energy and fatigued. 5/20/2024 - 5/23/2024 - Diagnosed with BLE Edema for lower extremities. Given Lasix as blood thinner. Low energy and fatigue. 7/1/2025 - 7/3/2025 - Chest wall mass identified and suspected as a hematoma from pacemaker lead drips. Surgery scheduled to wash away the hematoma. 7/11/2025 - 7/12/2025 - During surgery chest wall mass identified as a tumor and cut-out by heart surgeon. July 2025 - Tumor identified as Triple Negative Breast Cancer. August of 2025 - No chemo or radiation suggested at 87 years old, so sent to palliative care with diagnosis of Stage 4 Breast Cancer.

Current illness

None

Medical history

(07/16/2007) Right Breast - Low Grade duct carcinoma (0.6 cm) Removed/ Treated/ Not in lymph nodes. 14 yrs remission.

Other medications

Venlafaxine (150 mg)

Allergies

None

Lab data

5/3/2021 - Ejection Fraction low at 45-50% as tested at hospital 7/24/2021 - Negative for COVid 19. 7/30/2022 - Chest X-Ray clear. 2/1/2022 - Ejection fraction still low, so Cardiology referral. 2/22/2022 - Dr. ordered stress test and Echo-cardiogram. 3/16/2022 - Hospital noted patient in AFIB in ER room after fall with head injury intake.