Age: 45.0
Sex: M
Vaccine: COVID19, COVID19
Symptoms: Malaise, Mechanical ventilation, Mouth haemorrhage, Obstruction, Productive cough
Clinical narrative: A 47-year-old male, weighing 173 pounds, was healthy in adult life, had no chronic illnesses and took no medications. He had a normal physical exam and routine laboratories on September 15th , 2020. This was the last time he was examined by a doctor. He had no suspected or documented episodes of COVID-19 illness. On July 1st, 2021, he completed a COVID-19 vaccination primary series with two doses of BNT162b2.   SHOT 1  6/10/2021 SHOT 2 7/1/2021.  With each COVID-19 vaccine administration, he had an injection site reaction, malaise, weakness, and felt sufficiently ill that he could not work the next day. After recovery from the primary series, his only health encounter was a dental appointment where his blood pressure was found to be 134/87. Ten days before his death, on December 28th, 2022, there was a fire drill at work and the elevators where stopped, so he had to go up 10 flights of stairs after which he remarked to a colleague that he was out of breath. About three days before the date of death, both the patient and his wife were infected with a mild viral upper respiratory tract infection, and this was nearly resolved on the day of death. He awoke on the day of death with hoarseness. Throughout the day, his symptoms worsened. Around 12:30, the hoarseness became severe, and he could barely talk. The patient appeared to have fallen asleep around 14:50 on the floor and made some unusual snoring and gurgling sounds. His family noticed he was unresponsive and turning blue, so they called EMS for emergency medical assistance. The paramedic records indicate the estimated time of cardiac arrest was 15:00, the dispatch call was at 15:11, and the unit was on scene at 15:22. The paramedics indicated ?patient was bleeding profusely out of his mouth.? He received chest compressions and bag/valve ventilation throughout the resuscitation. The paramedics noted multiple times that profuse bleeding clogged up tubes, required suctioning and worked to prevent prompt airway access. The initial cardiac rhythm was ventricular fibrillation for which there were six defibrillation attempts at 360 J. He underwent successful endotracheal intubation on the second attempt at 15:45 and had intravenous lines placed. He received three doses of epinephrine 1:10, amiodarone 300 mg, 150 mg, normal saline 1000 ml, and tranexamic acid 1000 mg was given in an attempt to stop the hemorrhage. The patient remained unresponsive to these measures and was transported to the hospital where he was declared dead at 16:08 on January 7th, 2023, which was 555 days after the last COVID-19 vaccination. Postmortem Findings Gross examination revealed evidence of oral expectoration of blood during cardiac arrest and massively congested lungs with blood (Figure 1). An autopsy was performed by the Medical Examiner with the major findings of: 1) dark red, purple lungs with marked amounts of blood and frothy fluid, right lung weight 1552 g, left lung weight 1333 g (normal ~250 g [8]), no pulmonary embolism, 2) heart weight was normal 474 grams (normal < 500 g [9]) and myocardial tissue was normal, 3) coronary arteries estimated visually without detailed sectioning: left main normal, left anterior descending 90%, left circumflex 90%, right coronary 60%, stenoses without thrombus or occlusion, 4) moderate atherosclerosis in the aorta and basilar arteries to the neck, 5) there were multiple small faint contusions on the arms and legs. Pertinent negatives: no gastrointestinal or cerebral hemorrhage, no myocardial infarction, toxicology was negative, tests for COVID-19 and upper respiratory pathogens were negative. The medical examiner concluded that the patient died from atherosclerotic and hypertensive cardiovascular disease. However, the patient had no recorded history of hypertension and the pulmonary hemorrhage was not cited as the major cause of death or as a contributing factor by the medical examiner in the report or on or on the death certificate. There were no tissue stains for the mRNA or its encoded Spike protein.