이상반응 보고

VAERS ID 924664
성별 여성
나이 92세
주 코드 HI
제약회사 MODERNA
로트 번호 O11L20A
예방접종 횟수 1
접종일 2021-01-02
발병일 2021-01-05
상태 사망
증상
  • 자극에 무반응(Unresponsive to stimuli)
  • 컴퓨터 단층 촬영 비정상(Computerised tomogram abnormal)
  • 엑스레이 비정상(X-ray abnormal)
  • 죽음(Death)
  • 폐부종(Pulmonary oedema)
  • 두개내 동맥류(Intracranial aneurysm)

이환 중 질병

none

지병

history of stroke, hyperlipidemia, dementia, GERD, and macular degeneration

기타 의료

Metoprolol succ ER 50mg 1 tab PO daily Omeprazole DR 20mg 1 cap PO daily Amlodipine besylate 5mg 1 tab PO daily Aspirin 81mg 1 tab PO daily Carbamazepine ER 100mg 1 tab PO TID Docusate 100mg 1 cap PO daily Multivitamin 1 tab PO daily Olmesa

이전 예방접종

알레르기

Hydrochlorothiazide

임상 검사

CT scan, X ray 1/5/2021

증상 상세

At approximately, 1855, I was alerted by caregiver, resident was not responding.
Per caregiver, she was doing her rounds and found resident in bed, unresponsive, mouth open, observed gurgling noises and tongue hanging out of mouth.
This primary caregiver observed resident at baseline and ambulating after dinner at approximately, 1800 less than an hour prior to incident.
This PCG called 911 for EMS and gave report of incident.
Resident was taken to Medical Center Emergency Department.
At ER, CT scan and X-ray was performed.
Per report from ER RN, CT scan and x-ray revealed an intracranial aneurysm and fluid in the lungs.
Per RN, resident was still unresponsive and was admitted to Medical Center for observation and comfort measures.
This primary caregiver reported to RN, resident recently received the first dose of COVID-19 vaccine on 1/2/21.
Primary caregiver received a call from Castle RN at 0700, resident expired at 0615.