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From the 1/7/2022 release of VAERS data:

Found 6,644 cases where Vaccine is COVID19 and Manufacturer is MODERNA and Symptom is Cerebral venous sinus thrombosis or Cerebral venous thrombosis or Coagulopathy or Deep vein thrombosis or Disseminated intravascular coagulation or Embolism or Idiopathic thrombocytopenic purpura or Immune thrombocytopenia or Immune thrombocytopenic purpura or Ischaemic stroke or Myocardial infarction or Petechiae or Pulmonary embolism or Purpura or Thrombocytopenia or Thrombosis or Vasculitis

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Case Details

This is page 28 out of 665

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VAERS ID: 1054353 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-01-06
Onset:2021-01-16
   Days after vaccination:10
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026L20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Angioedema, Anti factor VIII antibody increased, Antiphospholipid antibodies, Aphasia, Atrial septal defect, Cerebral artery occlusion, Echocardiogram, Facial paresis, Hyperlipidaemia, Intensive care, Ischaemic stroke, Low density lipoprotein increased, Magnetic resonance imaging brain abnormal, Sleep study, Venogram normal, Von Willebrand's factor antigen increased
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Dyslipidaemia (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Ischaemic central nervous system vascular conditions (narrow), Dementia (broad), Congenital, familial and genetic disorders (narrow), Embolic and thrombotic events, arterial (narrow), Oropharyngeal allergic conditions (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Lipodystrophy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Culturelle 1 capsule qd Magnesium 30 mg po QD/prn
Current Illness: None
Preexisting Conditions: None
Allergies: Vyvanse [Lisdexamfetamine] Chest Pain High 12/21/2020 Past Updates... Pt states she had chest tightness Alteplase Angioedema Not Specified 1/17/2021 Past Updates... OF NOTE: pt has stated that if she were to need tPA in the future because of stroke that she believes benefit outweighs risk and would still like it administered if needed along with benadryl and solumedrol Cats Not Specified 7/6/2017 Past Updates... Dogs Not Specified 7/6/2017 Past Updates... Environmental Allergies Not Specified 1/23/2016 Past Updates... Grass Pollen Not Specified 7/6/2017 Past Updates... Not the drug Ibuprofen Not Specified 3/28/2008 Past Updates... --BLURRED VISION ; Nitrate Analogues Headache Not Specified 5/19/2017 Past Updates... Sulfites Headache Not Specified 5/19/2017 Past Updates... Tree And Shrub Pollen Not Specified 7/6/2017 Past Updates... Not the drug Yeast, Dried Not Specified 8/28/2014 Past Updates... Pt get headaches
Diagnostic Lab Data: 60-year-old woman with cryptogenic left MCA stroke. Good clinical outcome s/p IV tPA. Vessel imaging: no significant stenosis HTN/HLD/DM eval: HLD; started statin Sleep apnea screening: warranted as outpatient; moderate stop bang screening but loud snoring Cardioembolism eval: TTE w/ PFO, nl sized atria, EF 61% - outpatient 30 day monitor; likely warrants LINQ if negative - outpatient TEE if other eval negative, and could consider PFO closure AFTER all other eval negative Hypercoag: vWF activity WNL. vWF antigen slightly elevated at 208. factor VIII activity slightly elevated at 166. vWF abnormalities have been associated w/ endotheliopathy in acute COVID infection; while she does not have infection, we sent given crypto stroke, recent immunization. Would recheck von willebrand panel as outpatient. - antiphospholipid labs pending - anticipate factor V leiden/ APC and prothombin gene testing as outpatient given PFO LEUS and MRV pelvis negative
CDC Split Type:

Write-up: 10 daya after receiving Moderna vaccine: 60 year old right handed woman with migraine + chronic headaches, nephrolithiasis, who presented to the hospital with expressive aphasia and right facial weakness and was found to have at least to distal left MCA occlusions for which she received IV tPA. MRI brain shows a small left frontal cortical acute ischemic stroke. Post tPA ICU course has been notable for angioedema of the tongue now improved. TTE showed PFO. LDL 111, new diagnosis HLD.


VAERS ID: 1054520 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: New Jersey  
Vaccinated:2021-02-22
Onset:2021-02-23
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Work       Purchased by: ?
Symptoms: Petechiae
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data:
CDC Split Type:

Write-up: petechia to bilateral lower legs on 2nd day 2/23/21


VAERS ID: 1054540 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: Montana  
Vaccinated:2021-02-24
Onset:2021-02-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Bone pain, Chills, Nausea, Pain in extremity, Petechiae, Pyrexia, Vomiting
SMQs:, Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Osteonecrosis (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Severe nasua and vomiting, petechiae on face and neck, bone pain in left arm (arm that vaccine was administered), fever, chills


VAERS ID: 1055044 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-23
Onset:2021-02-24
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Gait inability, Hypoxia, Petechiae, Vaccination site rash
SMQs:, Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced generalized weakness and inability to ambulate. He presented to the ER on 2/24/21 and was found to be hypoxic 88% on room air and was stated on O2. He presented with a rash at site of vaccination on left arm over deltoid muscle. He had a red petechial rash on anterior chest and upper abdominal wall.


VAERS ID: 1055459 (history)  
Form: Version 2.0  
Age: 94.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-01-21
Onset:2021-02-14
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 011L20A / UNK - / IM

Administered by: Private       Purchased by: ?
Symptoms: Anaemia, Aspiration pleural cavity, Atelectasis, Blood creatinine increased, Blood glucose increased, Blood urea increased, Bradycardia, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Condition aggravated, Cough, Differential white blood cell count, Dyspnoea, Full blood count, Laboratory test, Magnetic resonance imaging abnormal, Pericardial effusion, Pleural effusion, Pneumothorax, Productive cough, Sputum normal, Thrombocytopenia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Anaphylactic reaction (broad), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Systemic lupus erythematosus (narrow), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Current Outpatient Medications: ? Alcohol Swabs (ALCOHOL PADS) 70 % PADS, Indications: Diabetes For use with insulin as ordered. DX E11.9, Disp: 100 each, Rfl: 11 ? amoxicillin-clavulanate (AUGMENTIN) 875-125 MG per tablet, Take 1 tablet
Current Illness:
Preexisting Conditions:
Allergies: sulfa antibiotics
Diagnostic Lab Data: . Large right pleural effusion. Most of the right lower lobe is collapsed. Superimposed infection cannot be excluded. 2. Small left pleural effusion with adjacent atelectasis. 3. Small pericardial effusion. Ordered CT Chest wo Contrast RAD ONE TIME 02/14/21 1207 CBC w Auto Diff ONE TIME 02/14/21 1103 Comprehensive metabolic panel ONE TIME 02/14/21 1103 XR Chest 2 View RAD ONE TIME 02/14/21 1042 2/25 history ed to admission at hospital History The patient is a 94 y.o. male with a history of peripheral vascular disease, diabetes, hypertension, atrial fibrillation not on anticoagulation, history of TAVR, CAD, CKD stage 4, prostate cancer on observation presents to us with a recurrent right-sided pleural effusion. Patient reports shortness of breath on exertion. Patient was recently admitted to the hospital for similar problem. This was found to be transudative in nature. Cytology was negative for malignancy. 2D echo in December 2020 showed normal systolic and diastolic dysfunction. Will send patient for ultrasound-guided thoracentesis and will get a 2D echo. CT Chest: 1. Large right pleural effusion causing large amount of right lower lobe compressive atelectasis. Right middle lobe is completely collapsed secondary to effusion. 2. Small left pleural effusion. 3. No definite pneumonia. No suspicious lung lesions are seen. 4. Trachea is moderately narrowed. This could be secondary to imaging during expiration but suspect this is due to mass effect on the posterior trachea by the large right pleural effusion. Of note, patient has no idea why he keeps getting these recurrent pleural effusions. He states that this all started after he swallowed a few pills of a stool softener without any water which subsequently caused pill esophagitis. His fluid buildup began 4 days after that event.
CDC Split Type:

Write-up: 2/14 Emergency room HPI Patient is a 94 y.o. male who presents with complaint of cough that started about a week ago, and was seen by primary care provider on the 9th February 2021. Patient was started on Augmentin and has taken it for about 5 days but said the cough is worse and productive of clear sputum. Patient in ER to get checked for pneumonia. Patient denies a fever or chills, shortness of breath, chest pain, nausea vomiting and no headache or dizziness. Transferred to another facility h&pHistory of Present Illness: 94-year-old former smoker with a history of paroxysmal atrial fibrillation not currently on anticoagulation, coronary artery disease, insulin-dependent diabetes, CKD 4, prostate cancer on surveillance, TAVR 2/17, with a son who is a doctor and a caregiver who is a Radiology NP by his report, who presents in transfer from previous Hospital due to a large right pleural effusion. He has had a cough for some time now, but thinks it may have worsened, at least per his caregiver, over the last 4-5 days. He was seen by his PCP on February 9th and placed on Augmentin, but nothing changed. He himself denies being short of breath, having any chest pain, fevers, chills, sweats, change in appetite, abdominal pain, nausea, vomiting, dysuria, diarrhea. Of note, on a chest x-ray in June he had bilateral pleural effusions, and on an MRI in July to investigate a renal mass, he was noted to have a small right-sided pleural effusion. On arrival to facility this morning, he was afebrile, normotensive, had a normal heart rate, sometimes mildly bradycardic, normal respiratory rate and saturations of 97% on room air. Labs demonstrated chronic anemia and thrombocytopenia, stable stage 4 kidney disease creatinine of 2.6, BUN 64, glucose 187. Chest x-ray demonstrated a moderate right pleural effusion, noting that underlying consolidation cannot be excluded. He was also felt to have bibasilar atelectasis. CT of the chest without contrast showed a large right pleural effusion with most of the right lower lobe being collapsed. Superimposed infection could not be excluded. He had a small left pleural effusion with adjacent atelectasis and a small pericardial effusion as well. EKG and procalcitonin were not performed. He was sent to our facility for thoracentesis. On arrival here, vitals remained stable. His bedside RN informed me that upon returning from the bathroom, he appeared to be a bit dyspneic, but the patient himself denies any shortness of breath or ?huffing and puffing?. 2/25 admEd to hospital admission


VAERS ID: 1055691 (history)  
Form: Version 2.0  
Age: 93.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-01-19
Onset:2021-01-20
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 027L20A / 1 - / SC

Administered by: Pharmacy       Purchased by: ?
Symptoms: Aspiration, Death, Ischaemic stroke, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, arterial (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-24
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zoloft, ASA, Lipitor
Current Illness: dyslipidemia, mild dementia, lumbar stenosis with indwelling suprapubic catheter - no known infection/symptoms of infection
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Massive ischemic stroke with aspiration, unable to arouse on the morning of 1/21/2021 and placed on Hospice with death 1/24/2021


VAERS ID: 1055752 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: South Dakota  
Vaccinated:2021-01-08
Onset:2021-02-01
   Days after vaccination:24
Submitted: 0000-00-00
Entered: 2021-02-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / SC

Administered by: Private       Purchased by: ?
Symptoms: Immune thrombocytopenia, Immunoglobulin therapy, Platelet count decreased, Steroid therapy, Vaginal haemorrhage
SMQs:, Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Platelets 7000
CDC Split Type:

Write-up: ITP noted appx 4 wks after 1st dose with heavy vaginal bleeding responsive to IVIG and steroids.


VAERS ID: 1056011 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-02-07
Onset:2021-02-10
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Cardiovascular disorder, Cerebrovascular accident, Death, Dyspnoea, Endotracheal intubation, Feeling abnormal, Hemiparesis, Sedation, Thrombosis
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Anticholinergic syndrome (broad), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Dementia (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Cardiomyopathy (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Respiratory failure (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-22
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Blood pressure medication, cholesterol medication, some other vitamins and supplements.
Current Illness: Kidney disease
Preexisting Conditions: Kidney disease
Allergies: None.
Diagnostic Lab Data:
CDC Split Type:

Write-up: My grandpa had a stroke on the 15th of February. He claimed he had been feeling "off" for a few days, but didn''t say anything. A blood clot had formed in his brain. He was doing better and about to go to rehab to strength his right side of his body. On the 22nd he took a turn for the worst. He was having trouble breathing and they sedated and partially paralyzed him to put a tube in his mouth. I believe another blood clot had formed and oxygen wasn''t properly going through his body. They could not stabilize him, and he passed away the same day.


VAERS ID: 1056518 (history)  
Form: Version 2.0  
Age: 84.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-01-18
Onset:2021-02-13
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 - / OT

Administered by: Unknown       Purchased by: ?
Symptoms: Myocardial infarction
SMQs:, Myocardial infarction (narrow), Embolic and thrombotic events, arterial (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-13
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: VITAMINS NOS
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Bypass surgery
Allergies:
Diagnostic Lab Data:
CDC Split Type: USMODERNATX, INC.MOD20210

Write-up: The coroner said it was some type of heart attack; A spontaneous Report Received from a Health care professional concerning a 84 year old male patient who received Moderna''s COVID-19 Vaccine (mRNA-1273) and who experienced a heart attack / myocardial infarction. The patient''s had undergone triple bypass surgery years ago. Concomitant medications were vitamins. On 18-Jan-2021 prior to onset of events the patient received his first of first two planned doses of (mRNA-1273) COVID-19 vaccine of unknown batch no, unknown route and unknown site of administration for prophylaxis of COVID-19 infection. On 13-Feb-2021 the patient experienced death 27 days after the first dose of the vaccine. The coroner said it was some type of heart attack and think he expired sometime Saturday 13-Feb-2021. On 16-Feb-2021 the patient was supposed to have his second dose of (mRNA-1273) COVID-19 vaccine. The event, heart attack, was fatal.; Reporter''s Comments: This is a case of death to heart attack in a 84-year-old female subject with a hx of triple bypass surgery, who died 27 days after receiving first dose of vaccine. Very limited information has been provided at this time. No death certificate provided. Further information has been requested.; Reported Cause(s) of Death: Unknown cause of Death


VAERS ID: 1056948 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-02-22
Onset:2021-02-22
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-02-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 031L20A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Asthenia, Chills, Decreased appetite, Fatigue, Immune thrombocytopenia, Pain in extremity, Pyrexia, Stomatitis
SMQs:, Severe cutaneous adverse reactions (broad), Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Primpro 1.5mg once daily, lisinopril/HCTZ 12.5mg once daily, OTC Prilosec every other day, OTC B6 200 mg once daily, OTC MagOx400 once daily,
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: Patient states took oral Sulfa medication several years ago and layed out in sun, then developed a rash. Unsure if allergic.
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Received notification from county director that patient is currently hospitalized beginning two days after Moderna vaccination, spoke to patient today 2/26/2021. Patient received vaccine Monday morning 2/22/2021 around 9:07am, by 9pm Monday evening patient reports weakness, fatigue, sore arm, fever, chills, and no appetite. Patient states symptoms persisted all day Tuesday 2/23/2021. On Wednesday 2/24/2021 at 11:30am patient was eating a peanut butter sandwich and felt something inside mouth. Upon looking in mouth patient noticed "black sores." Patient then called husband and was taken to ER and was then transferred to Hospital. Patient states she has been diagnosed with ITP idiopathic thrombocytopenic purpura.


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