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This is VAERS ID 1036675

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History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1036675
VAERS Form:2
Age:61.0
Sex:Female
Location:Michigan
Vaccinated:2021-01-28
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood creatinine increased, Blood culture negative, Blood urea increased, Cerebral haemorrhage, Chest X-ray abnormal, Condition aggravated, Death, Diarrhoea, Dyspnoea, Nausea, Oxygen saturation decreased, Paralysis, Pupillary disorder, Pupillary light reflex tests abnormal, Respiratory failure, White blood cell count increased, Ventricular drainage, Oesophagogastroduodenoscopy, Brain natriuretic peptide increased, Troponin increased, Culture negative, Viral test negative, Procalcitonin increased, Endotracheal intubation, Immunoglobulin therapy, Computerised tomogram head abnormal, Lung opacity, SARS-CoV-2 test negative

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-02-15
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: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: acyclovir (ZOVIRAX) 200 MG capsule Take 1 capsule by mouth 2 times daily. albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler Take 2 puffs by inhalation Every 4 hours as needed for Wheezing (shortness of br
Current Illness: ?
Preexisting Conditions: Bilateral Lung ?Transplant due to Advanced Lymphoangioleiomymatosis Immunosuppressed status (HCC) Antibody mediated rejection of lung transplant (HCC) Bronchiolitis obliterans syndrome, grade 0P (HCC) Major depressive disorder with single episode, in full remission (HCC) RLS (restless legs syndrome) Chronic insomnia Long term current use of systemic steroids OSA (obstructive sleep apnea) Iron deficiency anemia Bilateral sciatica Pure hypercholesterolemia Hoarseness of voice Memory change Laryngeal stridor Senile nuclear cataract, bilateral Myopia of both eyes Osteoporosis without current pathological fracture, unspecified osteoporosis type Dry eyes, bilateral
Allergies: Voriconazole, NSAIDs
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 61 yo F with history of bilateral lung transplant 6/23/17 presented to ED on 2/4/21 with chief complaint of worsening shortness of breath, nausea and diarrhea for past week since receiving since receiving COVID-19 vaccine (Pfizer) on 1/28/21. Upon arrival to triage she was obviously dyspneic with significantly low oxygen saturations. O2 sats on arrival were 65%, improved to mid 90''s with O2 6 liters per NC. Admitting diagnosis: hypoxic respiratory failure post COVID vaccine. Lab work shows an elevation of the BUN and creatinine at 31 and 1.71 which is slightly higher than her usual baseline levels. BNP is elevated at 2 448 with a mildly elevated troponin. Procalcitonin is also elevated. Patient''s white blood cell count is 11.07. Full viral panel including COVID-19 is not detected. All blood cultures and respiratory cultures were negative. Patient chest x-ray shows numerous bilateral patchy opacities which is significantly different from her previous chest x-ray here. Empiric rejection treatment initiated including high dose methylprednisolone, plasmapheresis, IVIG, Thymoglobulin. She continued to decline and ultimately required intubation, proning and paralyzing on 2/8/2021 and then VV ECMO cannulation on 2/13/2021. EGD done 2/14/2021 as unable to pass the TEE probe during cannulation prior day (unable to complete due to abnormal anatomy). Acute pupil exam change in the early am hours of 2/15/2021 prompted urgent head CT which revealed catastrophic brain bleed. Brainstem reflexes were lost soon after. Despite placing an EVD emergently at bedside, brain stem reflexes were not recovered. GOL engaged and patient not an organ donation candidate. Therefore discussion with sister at bedside resulted in decision for cessation of life support. Patient expired shortly after support withdrawn and pronounced dead on 2/15/2021 at 11:11 AM.


Changed on 5/7/2021

VAERS ID: 1036675 Before After
VAERS Form:2
Age:61.0
Sex:Female
Location:Michigan
Vaccinated:2021-01-28
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood creatinine increased, Blood culture negative, Blood urea increased, Cerebral haemorrhage, Chest X-ray abnormal, Condition aggravated, Death, Diarrhoea, Dyspnoea, Nausea, Oxygen saturation decreased, Paralysis, Pupillary disorder, Pupillary light reflex tests abnormal, Respiratory failure, White blood cell count increased, Ventricular drainage, Oesophagogastroduodenoscopy, Brain natriuretic peptide increased, Troponin increased, Culture negative, Viral test negative, Procalcitonin increased, Endotracheal intubation, Immunoglobulin therapy, Computerised tomogram head abnormal, Lung opacity, SARS-CoV-2 test negative

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-02-15
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: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: acyclovir (ZOVIRAX) 200 MG capsule Take 1 capsule by mouth 2 times daily. albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler Take 2 puffs by inhalation Every 4 hours as needed for Wheezing (shortness of br
Current Illness: ?  
Preexisting Conditions: Bilateral Lung ?Transplant  Transplant due to Advanced Lymphoangioleiomymatosis Immunosuppressed status (HCC) Antibody mediated rejection of lung transplant (HCC) Bronchiolitis obliterans syndrome, grade 0P (HCC) Major depressive disorder with single episode, in full remission (HCC) RLS (restless legs syndrome) Chronic insomnia Long term current use of systemic steroids OSA (obstructive sleep apnea) Iron deficiency anemia Bilateral sciatica Pure hypercholesterolemia Hoarseness of voice Memory change Laryngeal stridor Senile nuclear cataract, bilateral Myopia of both eyes Osteoporosis without current pathological fracture, unspecified osteoporosis type Dry eyes, bilateral
Allergies: Voriconazole, NSAIDs NSAIDs
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 61 yo F with history of bilateral lung transplant 6/23/17 presented to ED on 2/4/21 with chief complaint of worsening shortness of breath, nausea and diarrhea for past week since receiving since receiving COVID-19 vaccine (Pfizer) on 1/28/21. Upon arrival to triage she was obviously dyspneic with significantly low oxygen saturations. O2 sats on arrival were 65%, improved to mid 90''s with O2 6 liters per NC. Admitting diagnosis: hypoxic respiratory failure post COVID vaccine. Lab work shows an elevation of the BUN and creatinine at 31 and 1.71 which is slightly higher than her usual baseline levels. BNP is elevated at 2 448 with a mildly elevated troponin. Procalcitonin is also elevated. Patient''s white blood cell count is 11.07. Full viral panel including COVID-19 is not detected. All blood cultures and respiratory cultures were negative. Patient chest x-ray shows numerous bilateral patchy opacities which is significantly different from her previous chest x-ray here. Empiric rejection treatment initiated including high dose methylprednisolone, plasmapheresis, IVIG, Thymoglobulin. She continued to decline and ultimately required intubation, proning and paralyzing on 2/8/2021 and then VV ECMO cannulation on 2/13/2021. EGD done 2/14/2021 as unable to pass the TEE probe during cannulation prior day (unable to complete due to abnormal anatomy). Acute pupil exam change in the early am hours of 2/15/2021 prompted urgent head CT which revealed catastrophic brain bleed. Brainstem reflexes were lost soon after. Despite placing an EVD emergently at bedside, brain stem reflexes were not recovered. GOL engaged and patient not an organ donation candidate. Therefore discussion with sister at bedside resulted in decision for cessation of life support. Patient expired shortly after support withdrawn and pronounced dead on 2/15/2021 at 11:11 AM.


Changed on 5/14/2021

VAERS ID: 1036675 Before After
VAERS Form:2
Age:61.0
Sex:Female
Location:Michigan
Vaccinated:2021-01-28
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood creatinine increased, Blood culture negative, Blood urea increased, Cerebral haemorrhage, Chest X-ray abnormal, Condition aggravated, Death, Diarrhoea, Dyspnoea, Nausea, Oxygen saturation decreased, Paralysis, Pupillary disorder, Pupillary light reflex tests abnormal, Respiratory failure, White blood cell count increased, Ventricular drainage, Oesophagogastroduodenoscopy, Brain natriuretic peptide increased, Troponin increased, Culture negative, Viral test negative, Procalcitonin increased, Endotracheal intubation, Immunoglobulin therapy, Computerised tomogram head abnormal, Lung opacity, SARS-CoV-2 test negative

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-02-15
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: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: acyclovir (ZOVIRAX) 200 MG capsule Take 1 capsule by mouth 2 times daily. albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler Take 2 puffs by inhalation Every 4 hours as needed for Wheezing (shortness of br
Current Illness:   ?
Preexisting Conditions: Bilateral Lung  Transplant ?Transplant due to Advanced Lymphoangioleiomymatosis Immunosuppressed status (HCC) Antibody mediated rejection of lung transplant (HCC) Bronchiolitis obliterans syndrome, grade 0P (HCC) Major depressive disorder with single episode, in full remission (HCC) RLS (restless legs syndrome) Chronic insomnia Long term current use of systemic steroids OSA (obstructive sleep apnea) Iron deficiency anemia Bilateral sciatica Pure hypercholesterolemia Hoarseness of voice Memory change Laryngeal stridor Senile nuclear cataract, bilateral Myopia of both eyes Osteoporosis without current pathological fracture, unspecified osteoporosis type Dry eyes, bilateral
Allergies: Voriconazole, NSAIDs NSAIDs
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 61 yo F with history of bilateral lung transplant 6/23/17 presented to ED on 2/4/21 with chief complaint of worsening shortness of breath, nausea and diarrhea for past week since receiving since receiving COVID-19 vaccine (Pfizer) on 1/28/21. Upon arrival to triage she was obviously dyspneic with significantly low oxygen saturations. O2 sats on arrival were 65%, improved to mid 90''s with O2 6 liters per NC. Admitting diagnosis: hypoxic respiratory failure post COVID vaccine. Lab work shows an elevation of the BUN and creatinine at 31 and 1.71 which is slightly higher than her usual baseline levels. BNP is elevated at 2 448 with a mildly elevated troponin. Procalcitonin is also elevated. Patient''s white blood cell count is 11.07. Full viral panel including COVID-19 is not detected. All blood cultures and respiratory cultures were negative. Patient chest x-ray shows numerous bilateral patchy opacities which is significantly different from her previous chest x-ray here. Empiric rejection treatment initiated including high dose methylprednisolone, plasmapheresis, IVIG, Thymoglobulin. She continued to decline and ultimately required intubation, proning and paralyzing on 2/8/2021 and then VV ECMO cannulation on 2/13/2021. EGD done 2/14/2021 as unable to pass the TEE probe during cannulation prior day (unable to complete due to abnormal anatomy). Acute pupil exam change in the early am hours of 2/15/2021 prompted urgent head CT which revealed catastrophic brain bleed. Brainstem reflexes were lost soon after. Despite placing an EVD emergently at bedside, brain stem reflexes were not recovered. GOL engaged and patient not an organ donation candidate. Therefore discussion with sister at bedside resulted in decision for cessation of life support. Patient expired shortly after support withdrawn and pronounced dead on 2/15/2021 at 11:11 AM.


Changed on 8/6/2021

VAERS ID: 1036675 Before After
VAERS Form:2
Age:61.0
Sex:Female
Location:Michigan
Vaccinated:2021-01-28
Onset:2021-02-04
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL9261 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood creatinine increased, Blood culture negative, Blood urea increased, Cerebral haemorrhage, Chest X-ray abnormal, Condition aggravated, Death, Diarrhoea, Dyspnoea, Nausea, Oxygen saturation decreased, Paralysis, Pupillary disorder, Pupillary light reflex tests abnormal, Respiratory failure, White blood cell count increased, Ventricular drainage, Oesophagogastroduodenoscopy, Brain natriuretic peptide increased, Troponin increased, Culture negative, Viral test negative, Procalcitonin increased, Endotracheal intubation, Immunoglobulin therapy, Computerised tomogram head abnormal, Lung opacity, SARS-CoV-2 test negative

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-02-15
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: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: acyclovir (ZOVIRAX) 200 MG capsule Take 1 capsule by mouth 2 times daily. albuterol HFA (PROVENTIL HFA, VENTOLIN HFA, PROAIR HFA) 108 (90 Base) MCG/ACT inhaler Take 2 puffs by inhalation Every 4 hours as needed for Wheezing (shortness of br
Current Illness: ?
Preexisting Conditions: Bilateral Lung ?Transplant Transplant due to Advanced Lymphoangioleiomymatosis Immunosuppressed status (HCC) Antibody mediated rejection of lung transplant (HCC) Bronchiolitis obliterans syndrome, grade 0P (HCC) Major depressive disorder with single episode, in full remission (HCC) RLS (restless legs syndrome) Chronic insomnia Long term current use of systemic steroids OSA (obstructive sleep apnea) Iron deficiency anemia Bilateral sciatica Pure hypercholesterolemia Hoarseness of voice Memory change Laryngeal stridor Senile nuclear cataract, bilateral Myopia of both eyes Osteoporosis without current pathological fracture, unspecified osteoporosis type Dry eyes, bilateral
Allergies: Voriconazole, NSAIDs
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 61 yo F with history of bilateral lung transplant 6/23/17 presented to ED on 2/4/21 with chief complaint of worsening shortness of breath, nausea and diarrhea for past week since receiving since receiving COVID-19 vaccine (Pfizer) on 1/28/21. Upon arrival to triage she was obviously dyspneic with significantly low oxygen saturations. O2 sats on arrival were 65%, improved to mid 90''s with O2 6 liters per NC. Admitting diagnosis: hypoxic respiratory failure post COVID vaccine. Lab work shows an elevation of the BUN and creatinine at 31 and 1.71 which is slightly higher than her usual baseline levels. BNP is elevated at 2 448 with a mildly elevated troponin. Procalcitonin is also elevated. Patient''s white blood cell count is 11.07. Full viral panel including COVID-19 is not detected. All blood cultures and respiratory cultures were negative. Patient chest x-ray shows numerous bilateral patchy opacities which is significantly different from her previous chest x-ray here. Empiric rejection treatment initiated including high dose methylprednisolone, plasmapheresis, IVIG, Thymoglobulin. She continued to decline and ultimately required intubation, proning and paralyzing on 2/8/2021 and then VV ECMO cannulation on 2/13/2021. EGD done 2/14/2021 as unable to pass the TEE probe during cannulation prior day (unable to complete due to abnormal anatomy). Acute pupil exam change in the early am hours of 2/15/2021 prompted urgent head CT which revealed catastrophic brain bleed. Brainstem reflexes were lost soon after. Despite placing an EVD emergently at bedside, brain stem reflexes were not recovered. GOL engaged and patient not an organ donation candidate. Therefore discussion with sister at bedside resulted in decision for cessation of life support. Patient expired shortly after support withdrawn and pronounced dead on 2/15/2021 at 11:11 AM.

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