Age: 23.0
Sex: M
Vaccine: COVID19
Symptoms: Alanine aminotransferase, Aspartate aminotransferase, Biopsy skin, Blood alkaline phosphatase, Blood bicarbonate
Clinical narrative: refractory shock; Multisystem Inflammatory Syndrome in Adult; Toxic Epidermal Necrolysis; cardiac arrest from ventricular fibrillation; non-purulent conjunctivitis; COVID-19; This literature-non-study case was reported in a literature article and describes the occurrence of SHOCK (refractory shock), MULTISYSTEM INFLAMMATORY SYNDROME IN ADULTS (Multisystem Inflammatory Syndrome in Adult), TOXIC EPIDERMAL NECROLYSIS (Toxic Epidermal Necrolysis), CARDIAC ARREST (cardiac arrest from ventricular fibrillation) and CONJUNCTIVITIS (non-purulent conjunctivitis) in a 23-year-old male patient who received mRNA-1273 (Spikevax) for COVID-19 prophylaxis. The occurrence of additional non-serious events is detailed below.   LITERATURE REFERENCE:     No Medical History information was reported.   On an unknown date, the patient received second dose of mRNA-1273 (Spikevax) (unknown route) 1 dosage form. On an unknown date, received first dose of mRNA-1273 (Spikevax) (unknown route) dosage was changed to 1 dosage form. On an unknown date, the patient experienced SHOCK (refractory shock) (seriousness criteria death, hospitalization and medically significant), TOXIC EPIDERMAL NECROLYSIS (Toxic Epidermal Necrolysis) (seriousness criteria hospitalization and medically significant), CARDIAC ARREST (cardiac arrest from ventricular fibrillation) (seriousness criteria hospitalization and medically significant) and CONJUNCTIVITIS (non-purulent conjunctivitis) (seriousness criterion hospitalization). an unknown date, the patient experienced MULTISYSTEM INFLAMMATORY SYNDROME IN ADULTS (Multisystem Inflammatory Syndrome in Adult) (seriousness criteria hospitalization and medically significant) and COVID-19 (COVID-19). The patient was treated with METHYLPREDNISOLONE at a dose of 1 gram once a day; IMMUNOGLOBULINS NOS (IMMUNOGLOBULIN I.V) (intravenous) for Multisystem inflammatory syndrome in adults, at an unspecified dose and frequency and ANAKINRA for Multisystem inflammatory syndrome in adults, at an unspecified dose and frequency. The patient died on an unknown date. The reported cause of death was Refractory shock. It is unknown if an autopsy was performed. At the time of death, MULTISYSTEM INFLAMMATORY SYNDROME IN ADULTS (Multisystem Inflammatory Syndrome in Adult), TOXIC EPIDERMAL NECROLYSIS (Toxic Epidermal Necrolysis) and CONJUNCTIVITIS (non-purulent conjunctivitis) outcome was unknown, CARDIAC ARREST (cardiac arrest from ventricular fibrillation) was resolving and COVID-19 (COVID-19) had resolved.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On an unknown date, Alanine aminotransferase: 291 U/L. On an unknown date, Aspartate aminotransferase: 298 U/L. On an unknown date, Biopsy skin: Skin biopsy revealed epidermal necrobiosis with apoptosis consistent with Toxic Epidermal Necrolysis (TEN).. On an unknown date, Blood alkaline phosphatase: 106 U/L. On an unknown date, Blood bicarbonate: 20 mmol/L. On an unknown date, Blood bilirubin: 7.6 mg/dl. On an unknown date, Blood creatinine: 2.2 mg/dl. On an unknown date, Blood lactic acid: 5.1 mmol/L. On an unknown date, Blood pressure measurement: 116/78 mmHg. On an unknown date, Blood sodium: 126 mmol/L. On an unknown date, Blood urea: 30 mg/dl. On an unknown date, Body temperature: 97.3 degree F. On an unknown date, Computerised tomogram thorax: CT angiography of the chest showed clear lung fields without pulmonary embolism.. On an unknown date, Echocardiogram: Echocardiogram showed normal biventricular function and valves.. On an unknown date, Fibrin D dimer: 11.98 FEUug/mL. On an unknown date, Haemoglobin: 15.5 g/dL. On an unknown date, Heart rate: 164 per minute. On an unknown date, Laboratory test: An extensive infectious disease workup was negative.. On an unknown date, Oxygen saturation: 96 % On room air. On an unknown date, Physical examination: Physical exam revealed macular erythematous rash in his trunk and extremities. On an unknown date, Platelet count: 99 k/uL. On an unknown date, Procalcitonin: 14.71 ng/mL. On an unknown date, Serum ferritin: More than 7500 ng/mL. On an unknown date, Troponin I: 1359 pg/ml Peaked. On an unknown date, Ultrasound Doppler: (Negative) Negative. On an unknown date, White blood cell count: 4 k/uL.     For mRNA-1273 (Spikevax) (Unknown), the reporter did not provide any causality assessments.   Concomitant medications were not reported.  Patient presented to the emergency room with fevers, cough, shortness of breath, fatigue and painful rashes all over his body. 3 weeks prior, he was diagnosed with COVID-19 which was managed conservatively at home. He recovered within 3 days. Patient had received 2 doses of Moderna COVID-19 vaccine 6 months prior. He denied recent drug intake.  Treatment also included empiric antibiotics.  Over the next 2 days, there was progression of rash with sloughing of skin in his trunk, back and extremities with bullae on his legs, and thigh sparing the face.  On day 3, he had a cardiac arrest from ventricular fibrillation but was successfully resuscitated. Subsequently, he was intubated, and required escalating vasopressor support for shock. On day 5, he also developed non-purulent conjunctivitis. On day 6, he was transferred to a higher center with a burns unit. However, despite aggressive supportive measures he succumbed to refractory shock the following day.  Authors discussed that  patient fit the criteria for MIS-A outlined by CDC (1) with age >=21 years, fevers, rash with non-purulent conjunctivitis for primary clinical criteria, hypotension and thrombocytopenia for secondary clinical criteria, several laboratory criteria, negative infectious work-up with a history of recent COVID-19. It is unclear if the COVID-19 vaccine increased his risk of MIS-A.  This literature-non-study case, concerns a 23-year-old male patient, with no medical history reported, who experienced the unexpected, fatal and serious (due to death, hospitalization and medically significant) event of Shock(refractory shock) and the unexpected and serious (due to hospitalization and medically significant) events of Multisystem inflammatory syndrome in adults(AESI), Toxic epidermal necrolysis(AESI), Cardiac arrest, unexpected and serious (due to hospitalization) event of Conjunctivitis approximately 6 months after second dose of mRNA-1273 vaccination.  Patient presented to the emergency room with history of fever, cough, shortness of breath, fatigue and painful rashes all over his body. 3 weeks prior, he was diagnosed with COVID-19 which was managed conservatively at home and recovered within 3 days. He had received 2 doses of Moderna COVID-19 vaccine 6 months prior. He denied recent drug intake. On examination, Vitals were normal except for heart rate 164/min, Physical exam revealed macular erythematous rash in his trunk and extremities. Leukocyte count was 4 k/uL, hemoglobin 15.5 g/dL, platelets 99k/uL, sodium 126 mmol/L, bicarbonate 20 mmol/L, BUN 30 mg/dL, creatinine2.2 mg/dL, lactate 5.1 mmol/L, ferritin>7500 ng/mL, total bilirubin 7.6 mg/dL, AST 298 U/L, ALT 291 U/L, ALP 106 U/L, procalcitonin 14.71 ng/mL, D-dimer11.98 FEUug/mL. Troponin-I peaked at 1359 pg/mL. CT angiography of the chest ruled out pulmonary embolism. Venous doppler was negative. Echocardiogram showed normal biventricular function and valves. An extensive infectious disease workup was negative. He was suspected to have MIS-A from recent COVID-19. He was started on methylprednisolone 1g/day, intravenous immunoglobulin (IVIG), anakinra and empiric antibiotics. Over the next 2 days, there was progression of rash with sloughing of skin in his trunk, back and extremities with bullae on his legs, and thigh sparing the face (Skin biopsy revealed epidermal necrobiosis with apoptosis consistent with Toxic Epidermal Necrolysis (TEN). On day 3, he had a cardiac arrest from ventricular fibrillation but was successfully resuscitated. Subsequently, he was intubated, and required escalating vasopressor support for shock. On day 5, he also developed non purulent conjunctivitis. On day 6, he was transferred to a higher center with a burns unit. However, despite aggressive supportive measures he succumbed to refractory shock the following day. He died approximately 6 months after vaccination. The reported cause of death was Shock. It is unknown if an autopsy was performed. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Sender's Comments: This literature-non-study case, concerns a 23-year-old male patient, with no medical history reported, who experienced the unexpected, fatal and serious (due to death, hospitalization and medically significant) event of Shock(refractory shock) and the unexpected and serious (due to hospitalization and medically significant) events of Multisystem inflammatory syndrome in adults(AESI), Toxic epidermal necrolysis(AESI), Cardiac arrest, unexpected and serious (due to hospitalization) event of Conjunctivitis approximately 6 months after second dose of mRNA-1273 vaccination.  Patient presented to the emergency room with history of fever, cough, shortness of breath, fatigue and painful rashes all over his body. 3 weeks prior, he was diagnosed with COVID-19 which was managed conservatively at home and recovered within 3 days. He had received 2 doses of Moderna COVID-19 vaccine 6 months prior. He denied recent drug intake. On examination, Vitals were normal except for heart rate 164/min, Physical exam revealed macular erythematous rash in his trunk and extremities. Leukocyte count was 4 k/uL, hemoglobin 15.5 g/dL, platelets 99k/uL, sodium 126 mmol/L, bicarbonate 20 mmol/L, BUN 30 mg/dL, creatinine2.2 mg/dL, lactate 5.1 mmol/L, ferritin>7500 ng/mL, total bilirubin 7.6 mg/dL, AST 298 U/L, ALT 291 U/L, ALP 106 U/L, procalcitonin 14.71 ng/mL, D-dimer11.98 FEUug/mL. Troponin-I peaked at 1359 pg/mL. CT angiography of the chest ruled out pulmonary embolism. Venous doppler was negative. Echocardiogram showed normal biventricular function and valves. An extensive infectious disease workup was negative. He was suspected to have MIS-A from recent COVID-19. He was started on methylprednisolone 1g/day, intravenous immunoglobulin (IVIG), anakinra and empiric antibiotics. Over the next 2 days, there was progression of rash with sloughing of skin in his trunk, back and extremities with bullae on his legs, and thigh sparing the face (Skin biopsy revealed epidermal necrobiosis with apoptosis consistent with Toxic Epidermal Necrolysis (TEN). On day 3, he had a cardiac arrest from ventricular fibrillation but was successfully resuscitated. Subsequently, he was intubated, and required escalating vasopressor support for shock. On day 5, he also developed non purulent conjunctivitis. On day 6, he was transferred to a higher center with a burns unit. However, despite aggressive supportive measures he succumbed to refractory shock the following day. He died approximately 6 months after vaccination. The reported cause of death was Shock. It is unknown if an autopsy was performed. The benefit-risk relationship of mRNA-1273 is not affected by this report.; Reported Cause(s) of Death: refractory shock