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

This is VAERS ID 1038117

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Case Details

VAERS ID: 1038117 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Kentucky  
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-02-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Public       Purchased by: ?
Symptoms: Activated partial thromboplastin time normal, Acute kidney injury, Anaemia, Aspartate aminotransferase increased, Asthenia, Blood creatinine increased, Blood culture negative, Blood glucose increased, Blood magnesium normal, Blood phosphorus decreased, Blood potassium decreased, Blood thyroid stimulating hormone normal, Blood urea increased, Culture stool negative, Culture urine negative, Decreased appetite, Dehydration, Diarrhoea, Epistaxis, Haemoglobin decreased, Illness, International normalised ratio normal, Leukopenia, Malaise, Mean cell volume increased, Metabolic function test, Nausea, Neutrophil count decreased, Pancytopenia, Platelet count decreased, Protein total normal, Thrombocytopenia, Urinary system X-ray, Vomiting, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Acute pancreatitis (broad), Agranulocytosis (narrow), Haematopoietic cytopenias affecting more than one type of blood cell (narrow), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Systemic lupus erythematosus (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Myelodysplastic syndrome (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow), Hypokalaemia (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: fosamax 70mg weekly, norvasc 5mg daily, allopurinol 100mg daily, centrum silver one daily, diovan hct 320/12.5 one daily, eliquis 5mg BID, otc fiber tabs prn, otc fish oil, flonase nasal spray, folic acid 1mg one daily, methotrexate 2.5mg 5
Current Illness: None
Preexisting Conditions: Rheumatoid Arthritis, Polymyalgia Rheumatica, HTN, Chronic Kidney Disease Stage 2 with anemia of chronic disease, macrocytic anemia due to methotrexate, allergic rhinitis, gout, sarcoidosis, paroxysmal atrial fibrillation, remote history of rectal carcinoma s/p chemo/RT and low anterior resection 2011
Allergies: Sulfa
Diagnostic Lab Data: 1/26/21 (rheumatology appt) WBC 5.2, HGB 9.7, Platelets 252. 2/5/21 (ED visit 1) WBC 1.9, HGB 9.1, Platelets 157 CMP Glucose 162, BUN 32, Total protein 6.4, AST 51 otherwise within normal limits. 2/9/21 (health center) WBC 0.9 with ANC 215, HGB 8.7, MCV 93.4, Platelets 66 2/9/21 (ED visit 2, hospital admission) WBC 0.7, ANC 0. Hgb 7.9, MCV 103.3, Platelets 40, BUN 49, creatinine 1.7, potassium 3.3 INR 0.9, APTT 30.4, TSH 2.09, Mag 1.7, phosphorus 2.6, blood cultures no growth at 120 hours, urine culture 10K skin flora, KUB: dilated central bowel, possible colon
CDC Split Type:

Write-up: Moderna COVID-19 Vaccine given at local health department on 2/1/21. Patient developed nausea and loss of appetite post vaccine. Became weak and sought care at ED on 2/5/21. Found to have leukopenia, anemia. Hydrated and discharged home. Patient continued to feel unwell, developed vomiting and diarrhea (has chronic diarrhea since partial colectomy for remote colon CA, but symptoms were worse). Sought care at my health center on 2/9/21. In-house CBC revealed pancytopenia and patient was clinically ill-appearing and severely dehydrated. Patient was sent back to ED for further evaluation. Patient admitted and consults made to Hematology and GI. Stool culture and cdiff negative, Patient was hydrated and had electrolytes replaced. Acute renal failure present on admission resolved with IVF. Sepsis was ruled out. Developed epistaxis requiring 1 unit of platelets to which she had a moderate allergic reaction requiring steroids and benadryl. Severe thrombocytopenia treated with Peg Filgrastim. CBC improved and patient was discharged to follow up with heme/onc. Her methotrexate and eliquis was held.

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