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This is VAERS ID 1031909

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1031909
VAERS Form:2
Age:56.0
Sex:Female
Location:Florida
Vaccinated:2021-01-08
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Back pain, Blood creatinine increased, Blood lactate dehydrogenase increased, Death, Haemoglobin decreased, Platelet count decreased, Reticulocyte count increased, Thrombotic thrombocytopenic purpura, Red blood cell schistocytes

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen 650 mg PO q4h PRN for pain, amlodipine 10 mg PO daily, atenolol 100 mg PO daily, calcium carbonate/cholecalciferol 600 mg/200 mg PO BID, fluticasone 50 mcg per nare daily, HCTZ 25 mg PO daily, phentermine 37.5 mg PO AC breakfa
Current Illness: None known
Preexisting Conditions: Allergic rhinitis, insomnia, anxiety state, Sjogren''s disease, joint pain, GERD without esophagitis, hypertension, vulvar cysts, recurrent maxillary sinusitis, herpres
Allergies: amoxicillin (swelling), sulfur (swelling), loratadine (rash)
Diagnostic Lab Data: Hgb 5 g/dL Platelets 9k SCr 2 mg/dL LDH 1500 Elevated reticulocyte count
CDC 'Split Type':

Write-up: Pt received dose #1 of COVID-19 vaccine (Pfizer-BioNTech) on 12/18/20 and dose #2 ( Pfizer-BioNTech) on 1/8/21. On 1/30, patient was evaluated at urgent care due to back pain. No bloodwork done; metronidazole prescribed for 7 days. On 2/8, patient was admitted to outside hospital due to ongoing symptom progression. At time of admission, hgb 5 g/dL and plt 9k. Per Dr. (hematology/oncology), pt with schistocytes, LDH 1500, and elevated reticulocyte count consistent with thrombotic thrombocytopenic purpura (TTP). SCr $g2 mg/dL. Patient immediately treated with plasma exchange and steroids, however continued to decline. Patient expired on 2/14/21.


Changed on 5/7/2021

VAERS ID: 1031909 Before After
VAERS Form:2
Age:56.0
Sex:Female
Location:Florida
Vaccinated:2021-01-08
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Back pain, Blood creatinine increased, Blood lactate dehydrogenase increased, Death, Haemoglobin decreased, Platelet count decreased, Reticulocyte count increased, Thrombotic thrombocytopenic purpura, Red blood cell schistocytes

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen 650 mg PO q4h PRN for pain, amlodipine 10 mg PO daily, atenolol 100 mg PO daily, calcium carbonate/cholecalciferol 600 mg/200 mg PO BID, fluticasone 50 mcg per nare daily, HCTZ 25 mg PO daily, phentermine 37.5 mg PO AC breakfa
Current Illness: None known
Preexisting Conditions: Allergic rhinitis, insomnia, anxiety state, Sjogren''s disease, joint pain, GERD without esophagitis, hypertension, vulvar cysts, recurrent maxillary sinusitis, herpres
Allergies: amoxicillin (swelling), sulfur (swelling), loratadine (rash) (rash)
Diagnostic Lab Data: Hgb 5 g/dL Platelets 9k SCr 2 mg/dL LDH 1500 Elevated reticulocyte count
CDC 'Split Type':

Write-up: Pt received dose #1 of COVID-19 vaccine (Pfizer-BioNTech) on 12/18/20 and dose #2 ( Pfizer-BioNTech) on 1/8/21. On 1/30, patient was evaluated at urgent care due to back pain. No bloodwork done; metronidazole prescribed for 7 days. On 2/8, patient was admitted to outside hospital due to ongoing symptom progression. At time of admission, hgb 5 g/dL and plt 9k. Per Dr. (hematology/oncology), pt with schistocytes, LDH 1500, and elevated reticulocyte count consistent with thrombotic thrombocytopenic purpura (TTP). SCr $g2 mg/dL. Patient immediately treated with plasma exchange and steroids, however continued to decline. Patient expired on 2/14/21.


Changed on 5/14/2021

VAERS ID: 1031909 Before After
VAERS Form:2
Age:56.0
Sex:Female
Location:Florida
Vaccinated:2021-01-08
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / 2 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Back pain, Blood creatinine increased, Blood lactate dehydrogenase increased, Death, Haemoglobin decreased, Platelet count decreased, Reticulocyte count increased, Thrombotic thrombocytopenic purpura, Red blood cell schistocytes

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
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: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Acetaminophen 650 mg PO q4h PRN for pain, amlodipine 10 mg PO daily, atenolol 100 mg PO daily, calcium carbonate/cholecalciferol 600 mg/200 mg PO BID, fluticasone 50 mcg per nare daily, HCTZ 25 mg PO daily, phentermine 37.5 mg PO AC breakfa
Current Illness: None known
Preexisting Conditions: Allergic rhinitis, insomnia, anxiety state, Sjogren''s disease, joint pain, GERD without esophagitis, hypertension, vulvar cysts, recurrent maxillary sinusitis, herpres
Allergies: amoxicillin (swelling), sulfur (swelling), loratadine (rash) (rash)
Diagnostic Lab Data: Hgb 5 g/dL Platelets 9k SCr 2 mg/dL LDH 1500 Elevated reticulocyte count
CDC 'Split Type':

Write-up: Pt received dose #1 of COVID-19 vaccine (Pfizer-BioNTech) on 12/18/20 and dose #2 ( Pfizer-BioNTech) on 1/8/21. On 1/30, patient was evaluated at urgent care due to back pain. No bloodwork done; metronidazole prescribed for 7 days. On 2/8, patient was admitted to outside hospital due to ongoing symptom progression. At time of admission, hgb 5 g/dL and plt 9k. Per Dr. (hematology/oncology), pt with schistocytes, LDH 1500, and elevated reticulocyte count consistent with thrombotic thrombocytopenic purpura (TTP). SCr $g2 mg/dL. Patient immediately treated with plasma exchange and steroids, however continued to decline. Patient expired on 2/14/21.

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