Age: 38.0
Sex: M
Vaccine: COVID19
Symptoms: Blood lactic acid, Blood pressure measurement, Compartment syndrome, Electrocardiogram, Platelet count
Clinical narrative: fatal massive AMI/nausea/vomiting; Lower extremity compartment syndrome developed; Heart block; Ventricular fibrillation; This literature-non-study case was reported in a literature article and describes the occurrence of ACUTE MYOCARDIAL INFARCTION (fatal massive AMI/nausea/vomiting), COMPARTMENT SYNDROME (Lower extremity compartment syndrome developed), ATRIOVENTRICULAR BLOCK (Heart block) and VENTRICULAR FIBRILLATION (Ventricular fibrillation) in a 38-year-old male patient who received SPIKEVAX NOS (SPIKEVAX NOS) for COVID-19 prophylaxis.   LITERATURE REFERENCE:     Concurrent medical conditions included Obesity (body mass index 34.5 kg/m2).    On an unknown date, the patient received dose of SPIKEVAX NOS (SPIKEVAX NOS) (unknown route) 1 dosage form. On an unknown date, the patient experienced ACUTE MYOCARDIAL INFARCTION (fatal massive AMI/nausea/vomiting) (seriousness criteria death, hospitalization and medically significant), COMPARTMENT SYNDROME (Lower extremity compartment syndrome developed) (seriousness criteria hospitalization and medically significant), ATRIOVENTRICULAR BLOCK (Heart block) (seriousness criterion hospitalization) and VENTRICULAR FIBRILLATION (Ventricular fibrillation) (seriousness criteria hospitalization and medically significant). The patient was treated with Surgery (fasciotomies were performed in both legs) for Compartment syndrome. The patient died on an unknown date. The reported cause of death was fatal massive ami and Cardiac arrest. An autopsy was performed. At the time of death, COMPARTMENT SYNDROME (Lower extremity compartment syndrome developed), ATRIOVENTRICULAR BLOCK (Heart block) and VENTRICULAR FIBRILLATION (Ventricular fibrillation) outcome was unknown.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Angiogram: Angiography disclosed his epicardial coronary arteries to be normal. On an unknown date, Aspartate aminotransferase: 16089 daltons/L on serum glutamic-pyruvic transaminase 9532 U/L. On an unknown date, Blood creatine phosphokinase: 11138 daltons/L and increasing to greater than 100000 U/L. On an unknown date, Blood lactic acid: 20.3 millimole per litre. On an unknown date, Blood pressure measurement: The left ventricular pressure was 90/19 mm Hg and the aortic pressure was 90/60 mm Hg. His blood pressure decreased further.. On an unknown date, Electrocardiogram: 6 hours after vaccination, showed sinus rhythm with ST-elevation consistent with myocardial infarction and second electrocardiogram taken approximately 16 hours after vaccination, showed heart block associated with myocardial infarction. On an unknown date, Platelet count: decreasing to 40 thousand per microlitre and 356 thousand per microlitre. On an unknown date, Troponin: increasing to greater than 200 ng/mL and 25.3 ng/mL. On an unknown date, White blood cell count: 36.6 thousand per microlitre.     For SPIKEVAX NOS (SPIKEVAX NOS) (Unknown), the reporter did not provide any causality assessments.   No concomitant medications were reported.  A previously asymptomatic patient developed nausea, vomiting, and severe chest pain in the first 2 hours of his receiving the Moderna COVID-19 vaccine and he presented to the emergency department. The electrocardiogram 6 hours after vaccination was diagnostic of ST-elevation AMI and the second electrocardiogram taken approximately 16 hours after vaccination was indicative of a heart block associated with myocardial infarction. Before entering the cardiac catheterization laboratory shortly thereafter, he had the first of approximately 40 ventricular fibrillation cardiac arrests and each time, the sinus rhythm was successfully restored by defibrillation. Angiography disclosed his epicardial coronary arteries to be normal. The left ventricular pressure was 90/19 mm Hg and the aortic pressure was 90/60 mm Hg. His blood pressure decreased further, and venoarterial extracorporeal membrane oxygenation was initiated. The next day, a CP Impella was inserted. Lower extremity compartment syndrome developed, and fasciotomies were performed in both legs; shortly thereafter, fatal cardiac arrest occurred. At necropsy, the heart weighed 401 g. Massive necrosis was present in the left ventricular wall. The epicardial coronary arteries were normal (widely patent).  Additional literature cases were identified and were already reported: Case IDs MOD-2021-290649 and MOD-2021-290625.  Company Comment:   This literature-non-study case concerns a 38-year-old male patient, with underlying obesity, who experienced fatal AESI of Acute myocardial infarction, the unexpected and serious (due to hospitalization) AESI of Atrioventricular block, and serious events (due to hospitalization and medically significant) of Ventricular fibrillation (AESI) and Compartment syndrome, which occurred after an unspecified dose of SPIKEVAX NOS vaccine. As reported, the patient developed nausea, vomiting, and severe chest pain in the first 2 hours of his receiving vaccination and he presented to the emergency department. The white blood cell count was 36.6 K/mL, platelet count was 356 K/mL (decreasing to 40 K/mL), creatine kinase was 11,138 daltons/L (increasing to >100,000 U/L), lactic acid was 20.3 mmol/L, troponin was 25.3 ng/ml (increasing to >200 ng/ml), aspartate aminotransferase was 16,089 daltons/L on serum glutamic-pyruvic transaminase 9,532 U/L. The electrocardiogram 6 hours after vaccination was diagnostic of ST-elevation acute myocardial infarction (AMI) and the second electrocardiogram taken approximately 16 hours after vaccination was indicative of a heart block associated with myocardial infarction. Before entering the cardiac catheterization laboratory shortly thereafter, he had the first of approximately 40 ventricular fibrillation cardiac arrests and each time, the sinus rhythm was successfully restored by defibrillation. Angiography disclosed his epicardial coronary arteries to be normal. The left ventricular pressure was 90/19 mm Hg and the aortic pressure was 90/60 mm Hg. His blood pressure decreased further, and venoarterial extracorporeal membrane oxygenation was initiated. The next day, a CP Impella was inserted. Lower extremity compartment syndrome developed, and fasciotomies were performed in both legs; shortly thereafter, fatal cardiac arrest occurred. At necropsy, the heart weighed 401 g. Massive necrosis was present in the left ventricular wall. The epicardial coronary arteries were normal. Underlying obesity could be a confounding factor for the case. The benefit-risk relationship of SPIKEVAX NOS vaccine is not affected by this report.; Reported Cause(s) of Death: fatal massive AMI; cardiac arrest