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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1020280

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Case Details

VAERS ID: 1020280 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: New Mexico  
Vaccinated:2021-01-30
Onset:2021-02-04
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-02-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time normal, Angiogram pulmonary abnormal, Anion gap normal, Ascites, Basophil count decreased, Basophil percentage, Blood albumin decreased, Blood alkaline phosphatase increased, Blood bilirubin decreased, Blood calcium decreased, Blood chloride increased, Blood creatine normal, Blood glucose normal, Blood immunoglobulin G, Blood potassium normal, Blood sodium normal, Blood test, Blood urea normal, Carbon dioxide normal, Cholelithiasis, Computerised tomogram thorax abnormal, Differential white blood cell count normal, Eosinophil percentage, Haematocrit normal, Haemoglobin normal, Influenza A virus test negative, International normalised ratio normal, Lymphocyte count abnormal, Lymphocyte percentage, Mean cell haemoglobin, Mean cell haemoglobin concentration, Mean cell haemoglobin decreased, Mean cell volume abnormal, Mean platelet volume normal, Monocyte count decreased, Monocyte percentage, Neutrophil count normal, Neutrophil percentage, Peripheral swelling, Platelet count normal, Protein total decreased, Prothrombin time shortened, Pulmonary embolism, Red blood cell count increased, Red cell distribution width increased, Respiratory syncytial virus test negative, SARS-CoV-2 test negative, Tachycardia, Ultrasound Doppler, Ultrasound Doppler normal, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Acute pancreatitis (broad), Angioedema (broad), Haematopoietic leukopenia (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, venous (narrow), Biliary system related investigations, signs and symptoms (broad), Gallbladder related disorders (narrow), Gallstone related disorders (narrow), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: FUROSEMIDE 20MG TABLET TAKE ONE (1) TABLET BY MOUTH EVERY ACTIVE MORNING FOR EXCESS FLUID LIDOCAINE 5% PATCH APPLY 1 PATCH TO CLEAN NON-HAIRY AREA ACTIVE ON SKIN DAILY *LEAVE ON FOR 12 HOURS AND THEN REMOVE FOR 12 HOURS* LISINOPR
Current Illness: 12/22/20 was in Emergency room for a viral URI with a negative COVID test.
Preexisting Conditions: 1)Nephrotic syndrome - 2)Proteinuria - 3) Pre DM 4) Obesity
Allergies: No known drug allergies
Diagnostic Lab Data: 2/4/21 CTA of the chest: Bilateral lower lobe pulmonary emboli. Mild ascites. Cholelithiasis. 2/4/21 LE doppler, left leg: Examination difficult to perform, no definite thrombosis. Suspect that the findings are due to lymphedema. Perhaps compression hose fitting would be appropriate. 2/4/21 Labs: Specimen: BLOOD. Spec Collect Date/Time: 02/04/2021 2:36 PM Lab Arrival Date/Time: 02/04/2021 2:45 PM Res Site Test name Result Flg Units Ref. range Code Result Dt/Time _PT (TOP) 10.6 sec 9.8 - 12.8 [3873] 02/04/21 15:13 _INR (TOP) 0.93 0.85 - 1.11 [3873] 02/04/21 15:13 PTT (TOP) 34.8 sec 25.1 - 36.5 [3873] 02/04/21 15:13 Performing Lab Site(s): ============================================================================================================================ KEY: A=Abnormal L=Abnormal Low H=Abnormal High *=Critical value TR=Therapeutic Range Specimen: BLOOD. Spec Collect Date/Time: 02/04/2021 2:36 PM Lab Arrival Date/Time: 02/04/2021 2:45 PM Res Site Test name Result Flg Units Ref. range Code Result Dt/Time WBC-XE 5.80 10*3/uL 4.39 - 10.61 [3873] 02/04/21 15:00 RBC-XE 5.97 H M/uL 4.60 - 5.86 [3873] 02/04/21 15:00 HGB-XE 15.7 g/dL 14.0 - 17.7 [3873] 02/04/21 15:00 HCT-XE 49.4 % 41.1 - 52.7 [3873] 02/04/21 15:00 MCV-XE 82.7 fL 79.7 - 99.9 [3873] 02/04/21 15:00 MCH-XE 26.3 L pg 27.0 - 33.6 [3873] 02/04/21 15:00 MCHC-XE 31.8 L g/dL 32.3 - 35.3 [3873] 02/04/21 15:00 PLT-XE 239 10*3/uL 125 - 400 [3873] 02/04/21 15:00 MPV-XE 8.9 L fL 9.0 - 11.6 [3873] 02/04/21 15:00 NEUT% 70.8 % 46.7 - 78.5 [3873] 02/04/21 15:00 LYMPH% 20.1 % 9.7 - 46.8 [3873] 02/04/21 15:00 MONO% 5.0 % 1.2 - 13.2 [3873] 02/04/21 15:00 EO% 3.3 % 0.0 - 5.8 [3873] 02/04/21 15:00 BASO% 0.5 % 0.0 - 1.0 [3873] 02/04/21 15:00 NRBC 0.0 /100WBC 0.0 - 1.0 [3873] 02/04/21 15:00 IM GRAN% 0.3 % 0.0 - 0.8 [3873] 02/04/21 15:00 RDW-XE 15.8 H % 12.0 - 14.8 [3873] 02/04/21 15:00 NEUT# 4.07 10*3/uL 1.78 - 5.38 [3873] 02/04/21 15:00 LYMPH# 1.16 L 10*3/uL 1.32 - 3.57 [3873] 02/04/21 15:00 MONO# 0.29 L 10*3/uL 0.30 - 0.82 [3873] 02/04/21 15:00 EO# 0.19 10*3/uL 0.04 - 0.54 [3873] 02/04/21 15:00 BASO# 0.03 10*3/uL 0.01 - 0.08 [3873] 02/04/21 15:00 IG# 0.02 10*3/uL [3873] 02/04/21 15:00 NRBC# 0.00 10*3/uL 0.00 - 0.01 [3873] 02/04/21 15:00 Performing Lab Site(s): ============================================================================================================================== KEY: A=Abnormal L=Abnormal Low H=Abnormal High *=Critical value TR=Therapeutic Range Specimen: BLOOD. Spec Collect Date/Time: 02/04/2021 2:36 PM Lab Arrival Date/Time: 02/04/2021 2:44 PM Res Site Test name Result Flg Units Ref. range Code Result Dt/Time _CALCULATED OSMOLALITY 297 H mOsm/kg 275 - 295 [3873] 02/04/21 15:37 Eval: Neonatal: may be as low as 266 Eval: $g60 yrs old: 280 - 301 T BILI-19 0.7 mg/dL 0.1 - 1.2 [3873] 02/04/21 15:37 Eval: Per manufactures instructions, intereferance substance of IgG $g28 gm/L Eval: may affect Total Bilirubin results. Clincal judgement is recommended. No Eval: significant interference was shown in the bilirubin concentration Eval: ranges $g5.9 mg/dL, medical risk for the newborn population is most Eval: unlikely. GLUCOSE-RANDOM-09 93.0 mg/dL 74.0 - 106.0 [3873] 02/04/21 15:37 Eval: NEONATES: 40 - 60 mg/dL Eval: CHILDREN: 60 - 100 mg/dL BUN-09 6.0 mg/dl 6.0 - 20.0 [3873] 02/04/21 15:37 Eval: 18 - 60 year old = 6-20 mg/dL Eval: 60 - 90 year old = 8-23 mg/dL CREATININE 0.6 mg/dL 0.5 - 1.5 [3873] 02/04/21 15:37 SODIUM-09 141.0 mEQ/L 136.0 - 145.0 [3873] 02/04/21 15:37 POTASSIUM-09 4.1 mEQ/L 3.5 - 5.1 [3873] 02/04/21 15:37 Eval: PLASMA reference range: 3.4 - 4.5 mmol/L CHLORIDE-09 107.5 H mEQ/L 98.0 - 107.0 [3873] 02/04/21 15:37 CO2-09 24.0 mEQ/L 22.0 - 29.0 [3873] 02/04/21 15:37 ANION GAP-09 10.00 0.00 - 14.00 [3873] 02/04/21 15:37 CALCIUM-09 8.2 L mg/dL 8.6 - 10.2 [3873] 02/04/21 15:37 T PROTEIN-09 5.6 L gm/dL 6.6 - 8.7 [3873] 02/04/21 15:37 ALBUMIN-09 2.6 L gm/dL 3.5 - 5.2 [3873] 02/04/21 15:37 ALK PHOS-09 122.0 IU/L 42.0 - 134.0 [3873] 02/04/21 15:37 Eval: CHILDREN: Eval: <1 day old: <260 U/L Eval: 6 days-6 months: <467 U/L Eval: 1-3 yrs: <292 U/L Eval: 1-12 years: <312 U/L Eval: 13-17 yrs(f): <195 U/L Eval: 13-17 yrs(m): <406 U/L AST-09 21.0 IU/L 10.0 - 40.0 [3873] 02/04/21 15:37 ALT-09 22.0 IU/L 10.0 - 41.0 [3873] 02/04/21 15:37 ESTIMATED GFR $g60 mL/min [3873] 02/04/21 15:37 Specimen: NASOPHARYNGEAL CAVITY. Spec Collect Date/Time: 02/04/2021 12:45 PM Lab Arrival Date/Time: 02/04/2021 2:05 PM Res Site Test name Result Flg Units Ref. range Code Result Dt/Time _FLU A (Gx) NEGATIVE [3873] 02/04/21 14:57 _FLU B (Gx) NEGATIVE [3873] 02/04/21 14:57 _RSV (Gx) NEGATIVE [3873] 02/04/21 14:57 Internal QC 4PLEX VALID [3873] 02/04/21 14:57 _SARS (GX) NEGATIVE [3873] 02/04/21 14:57 Eval: POSITIVE-The 2019 novel coronavirus (SARS-CoV-2) target nucleic acids are Eval: detected. Eval: Eval: PRESUMPTIVE POSITIVE- The 2019 novel coronavirus (SARS-CoV-2) target Eval: nucleic acids may be present. Sample is retested. For samples with Eval: repeated presumptove positive results, additional confirmatory testing Eval: may be conducted to differentiate between SARs-CoV-2 and SARS-CoV-1 or Eval: othr Sarbecovirus currently unknown to infect humans, for epidemiological Eval: purposes or clinical management. Eval: Eval: NEGATIVE- The 2019 novel coronavirus (SARS-CoV-2) target nucleic acids Eval: are not detected.
CDC Split Type:

Write-up: Pt is a 33 y/o male who presents to the ED with c/o of left le swelling progressing over the last 4 days. Pt has no other c/o. Denies fever, cough, cp, abd pain, n/v/d. Pt has had his first COVID vaccine 1/30. Patient was noted to be tachycardic to the 120''s in the ER, after 1L of normal saline still tachycardic to the 110''s. Lower extremity doppler was negative for DVT, however PE protocol CTA of the chest was positive for a PE, report follows. Patient was given lovenox and flown to Medical Center for higher level of care.


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