Report #2860254

Received Sep 21, 2025

HospitalizedDisabled

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Overview

Sex: Male
Age: 47 yrs
State: TN
Recovered: Not recovered
Vaccinated: Mar 1, 2021
Onset: Oct 1, 2021
Days to onset: 214
Hospital days: 15

Vaccines (2)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	004M20A	SYR / AR
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	2	025A21A	SYR / AR

Symptoms (7)

Cardiac arrestCardiac failure congestiveCondition aggravatedDyspnoeaEchocardiogramEjection fraction decreasedPulmonary embolism

Symptom narrative

Started noticing shortness of breath a few months after vax. Entered emergency room for testing 31 Oct 2021 to discover blot clotted lungs. Pulmonary Embolism / cardiac arrest 1 Nov 2021 which resulted in chronic congestive heart failure with 12percent LF ejection fraction

Current illness

None

Medical history

chronic congestive heart failure

Other medications

None

Allergies

None

Lab data

CV ECHO 2D Comp