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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1024791

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Case Details

VAERS ID: 1024791 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-01-25
Onset:2021-02-01
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-02-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Blood creatinine normal, Blood urea normal, Ecchymosis, Epistaxis, Gingival bleeding, Glomerular filtration rate decreased, Haemoglobin decreased, Immune thrombocytopenia, Immunoglobulin therapy, Petechiae, Platelet count decreased, Thrombocytopenia, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (narrow), Gingival disorders (narrow), Chronic kidney disease (broad), Hypersensitivity (narrow), Tumour lysis syndrome (broad), 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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: sertraline, docusate, melatonin, pantoprazole, senna
Current Illness:
Preexisting Conditions: Chronic Lewy Body dementia, depression, frailty
Allergies: adhesive tape
Diagnostic Lab Data: 2/1/21 platelets 2000, hemoglobin 8.3 2/4/21 platelets UNDETECTABLE 2/5 platelets 1000 2/7 platelets 3000 2/8 platelets 19000 2/9 platelets 66000 2/10 platelets 164000, hemoglobin 10 WBC''s 6000-10000 BUN/CR 19/0.8, GFR 60
CDC Split Type:

Write-up: Patient developed severe thrombocytopenia, consistent with ITP. He was admitted to the hospital with this condition on 2/1/21 after developing diffuse petechiae, ecchymoses, epistaxis, and gingival bleeding over the preceding few days. He required steroids, IVIG, and rituximab. Initial platelet count on admission 2000, dropped as low as undetectable to 1000. Normalized/improved to 164,000 after 9 days in the hospital and multiple treatments. NOTE: patient had a prior episode of ITP in 2011. Please note date of Covid-19 vaccine and manufacturer are not certain.


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