National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts.org
Search Results

This is VAERS ID 1023612

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1023612
VAERS Form:2
Age:54.0
Sex:Female
Location:Florida
Vaccinated:2021-01-15
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
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, Petechiae, Platelet count decreased, Red blood cell sedimentation rate increased, Immune thrombocytopenia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 5/7/2021

VAERS ID: 1023612 Before After
VAERS Form:2
Age:54.0
Sex:Female
Location:Florida
Vaccinated:2021-01-15
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
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, Petechiae, Platelet count decreased, Red blood cell sedimentation rate increased, Immune thrombocytopenia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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) 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.


Changed on 5/21/2021

VAERS ID: 1023612 Before After
VAERS Form:2
Age:54.0
Sex:Female
Location:Florida
Vaccinated:2021-01-15
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
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, Petechiae, Platelet count decreased, Red blood cell sedimentation rate increased, Immune thrombocytopenia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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) 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.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1023612&WAYBACKHISTORY=ON


Copyright © 2022 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166