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

This is VAERS ID 1023612

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Case Details

VAERS ID: 1023612 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-15
Onset:2021-01-21
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 1 UN / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL8982 / 2 - / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood fibrinogen increased, Blood lactate dehydrogenase increased, Coombs direct test negative, Fibrin D dimer increased, Haemoglobin decreased, Immune thrombocytopenia, Petechiae, Platelet count decreased, Red blood cell sedimentation rate increased
SMQs:, Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Anoro Ellipta inhaler - 1 inhalation once a day Baclofen 10mg PO QHS folic acid 0.5mg PO daily Lexapro 10mg PO daily Lopressor 25mg PO BID oxybutynin 24hr ER tab 5mg PO daily Pravastatin 40mg tab take 1.5 tabs PO daily Tizanidine 4mg PO Q8H
Current Illness: Patient states she had some shortness of breath before initial dose, was worked up by her primary care with no cause identified and no treatment necessary
Preexisting Conditions: Chronic kidney disease, hypertension, ectodermal dysplasia, uterus didelphys, obstructive sleep apnea, hyperlipidemia, depression, anxiety
Allergies: Prednisone - causes fast heart rate (not true allergy)
Diagnostic Lab Data: 2/10/21 04:50 Hemoglobin 10.4 g/dL, platelet 0 per mL 2/10/21 13:48 Dimer quantitative 2.99mg/L, Fibrinogen 410 mg/dL, WSR 56 mm/hr, 2/10/21 21:00 lactate dehydrogenase 271 U/L, direct coombs neg
CDC Split Type:

Write-up: Patient received dose 1 of COVID-19 vaccine on 1/15/2021 and dose 2 on 2/5/2021. Approximately 1 week after the 1st dose, patient said she developed a rash. On presentation on 2/10/21, the rash appeared to be petechial in nature. Prior to coming to the hospital, the patient had blood work done at her ALF and was told she had zero platelets and she was sent to the hospital. Admission labs at the hospital on 2/10 also showed zero platelets and immune thrombocytopenia is suspected.


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