Age: 59.0
Sex: M
Vaccine: COVID19
Symptoms: Alanine aminotransferase, Anion gap, Anti-cyclic citrullinated peptide antibody, Anti-glomerular basement membrane antibody, Antineutrophil cytoplasmic antibody
Clinical narrative: This literature-non-study case was reported in a literature article and describes the occurrence of PULMONARY ALVEOLAR HAEMORRHAGE (Vaccine-associated diffuse alveolar hemorrhage) in a 59-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 vaccination. LITERATURE REFERENCE:- A case of diffuse alveolar hemorrhage with COVID-19 vaccination. 2022;14 (1):e21665. The patient's past medical history included COVID-19 pneumonia (The patient had been admitted at an outside hospital with a COVID-19 infection for a week). Previously administered products included for COVID-19 pneumonia: Dexamethasone and Remdesivir. Concurrent medical conditions included Hypertension, Diabetes mellitus, Chronic kidney disease stage 3 and Benign prostatic hyperplasia. On an unknown date, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On an unknown date, the patient experienced PULMONARY ALVEOLAR HAEMORRHAGE (Vaccine-associated diffuse alveolar hemorrhage) (seriousness criteria hospitalization, medically significant and life threatening). The patient was treated with METHYLPREDNISOLONE (intravenous) for Adverse event, at a dose of 1 milligram/kilogram twice a day. At the time of the report, PULMONARY ALVEOLAR HAEMORRHAGE (Vaccine-associated diffuse alveolar hemorrhage) was resolving.  DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available):  On an unknown date, Alanine aminotransferase (7-52): 79 iu/l (High) 79 IU/L.  On an unknown date, Anion gap (6-14): 15 mmol/l (High) 15 mmol/L.  On an unknown date, Anti-cyclic citrullinated peptide antibody: negative (Negative) Negative.  On an unknown date, Anti-glomerular basement membrane antibody: negative (Negative) Negative. On an unknown date, Antineutrophil cytoplasmic antibody: negative (Negative) Negative. On an unknown date, Aspartate aminotransferase (13-39): 43 iu/l (High) 43 IU/L. On an unknown date, Blood alkaline phosphatase (40-129): 181 iu/l (High) 181 IU/L. On an unknown date, Blood creatinine (0.6-1.3): 3.03 mg/dl (High) 3.03 mg/dl. On an unknown date, Blood gases: revealed mixed respiratory and metabolic acidosis (abnormal) Revealed mixed respiratory and metabolic acidosis with a pH of 7.. On an unknown date, Blood urea (7-25): 38 mg/dl (High) 38 mg/dl. On an unknown date, Bronchoalveolar lavage: negative (Negative) Negative. On an unknown date, Bronchoscopy: revealed copious amounts of blood in the bronchial (abnormal) Revealed copious amounts of blood in the bronchial wash, which increased with each subsequent wash. On an unknown date, Carbon dioxide (21-31): 15 mmol/l (Low) 15 mmol/L. On an unknown date, Chest X-ray: showed diffuse bilateral multifocal opacities (abnormal) Showed diffuse bilateral multifocal opacities. On an unknown date, Complement factor C3: negative (Negative) Negative. On an unknown date, Complement factor C4: negative (Negative) Negative. On an unknown date, Computerised tomogram thorax: showed patchy bilateral interstitial and alveolar (abnormal) Showed patchy bilateral interstitial and alveolar infiltrates with small bilateral effusions. On an unknown date, Cryoglobulins: negative (Negative) Negative. On an unknown date, Culture: negative (Negative) Negative. On an unknown date, Double stranded DNA antibody: negative (Negative) Negative. On an unknown date, Haemoglobin (13-17): 10.2 g/dl (Low) 10.2 g/dl. On an unknown date, Lymphocyte count (10-47): 2% (Low) 2%. On an unknown date, Mean cell haemoglobin (26-34): 23.3 pg (Low) 23.3 pg. On an unknown date, Mean cell haemoglobin concentration (32.5-35.8): 32.3 % (Low) 32.3 %. On an unknown date, Mean cell volume (80-100): 72.1 fl (Low) 72.1 fl. On an unknown date, Monocyte count (3-13): 2% (Low) 2%. On an unknown date, Neutrophil count (55-75): 92 % (High) 92 %. On an unknown date, Oxygen saturation: 80 % (Low) 80 %. On an unknown date, Physical examination: revealed crackles in bilateral lung fields (abnormal) Revealed crackles in bilateral lung fields on auscultation.. On an unknown date, Platelet count (150-450): 145 k/mm cu (Low) 145 k/mm cu. On an unknown date, Polymerase chain reaction: negative (Negative) Negative. On an unknown date, Red blood cell count (4.34-5.60): 4.37 m/mm cu (normal) 4.37 m/mm cu. On an unknown date, Rheumatoid factor: negative (Negative) Negative. On an unknown date, White blood cell count (4-11): 13.7 k/mm cu (High) 13.7 k/mm cu. The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown. For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter considered PULMONARY ALVEOLAR HAEMORRHAGE (Vaccine-associated diffuse alveolar hemorrhage) to be related. Concomitant medications were not reported. Company comment: This case concerns a 59-year-old male patient with a medical history of COVID-19 infection and COVID-19 Pneumonia, who experienced the unexpected serious event of pulmonary alveolar haemorrhage, approximately few hours after the first dose of mRNA-1273 vaccine. The patient experienced shortness of breath and chest pain and required urgent intubation and was admitted to the intensive care unit. The patient subsequently experienced shock requiring vasopressor support. Bronchoscopy revealed copious amounts of blood in the bronchial wash, which increased with each subsequent wash. Chest X-ray showed diffuse bilateral multifocal opacities. Computerised tomography of thorax showed patchy bilateral interstitial and alveolar infiltrates with small bilateral effusions. The patient was treated with intravenous methylprednisolone and broad-spectrum antibiotics for empiric coverage of possible superimposed pneumonia. The patient remained stable on steroids and antibiotics and was discharged on an extended tapering course of oral steroids for five to six weeks. Outcome reported as resolving at the time of reporting. History of COVID-19 infection is a confounder. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report. Most recent FOLLOW-UP information incorporated above includes: On 10-Mar-2022: Follow up received by safety on 10-Mar-2022 has Email with full text article received from SARA team and contains significant information: Reporter details, patient medical history, laboratory details, event seriousness, treatment details were updated. Sender's Comments: This case concerns a 59-year-old male patient with a medical history of COVID-19 infection and COVID-19 Pneumonia, who experienced the unexpected serious event of pulmonary alveolar haemorrhage, approximately few hours after the first dose of mRNA-1273 vaccine. The patient experienced shortness of breath and chest pain and required urgent intubation and was admitted to the intensive care unit. The patient subsequently experienced shock requiring vasopressor support. Bronchoscopy revealed copious amounts of blood in the bronchial wash, which increased with each subsequent wash. Chest X-ray showed diffuse bilateral multifocal opacities. Computerised tomography of thorax showed patchy bilateral interstitial and alveolar infiltrates with small bilateral effusions. The patient was treated with intravenous methylprednisolone and broad-spectrum antibiotics for empiric coverage of possible superimposed pneumonia. The patient remained stable on steroids and antibiotics and was discharged on an extended tapering course of oral steroids for five to six weeks. Outcome reported as resolving at the time of reporting. History of COVID-19 infection is a confounder. The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.