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Report #2859964

Received Sep 19, 2025

DiedLife-threateningHospitalizedER / ED visit
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
30 yrs
State
GA
Recovered
Not recovered
Vaccinated
Aug 1, 2021
Onset
Aug 1, 2021
Days to onset
0
Hospital days
107

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNAUNK—SYR / AR

Symptoms (9)

Central venous catheterisationDeathDialysisDyspnoeaEndotracheal intubationLung assist device therapyOxygen saturation decreasedPneumothoraxTracheostomy

Symptom narrative

Couldn?t breathe, 02 dropped below 60. Had to get med flight to facility. He had to get ecmo, trach, dialysis pick lines tubes for collapsed lungs hand up passing away on November 26, 2021.

Current illness

None

Medical history

None

Other medications

None

Allergies

None

Lab data

Hospital for 2 weeks in Aug 2021. Intubated and Ecmo put in and then med flighted to facility where he fought for four months before passing away on November 26, 2021.