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This is VAERS ID 1051651

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1051651
VAERS Form:2
Age:58.0
Sex:Male
Location:New York
Vaccinated:2021-02-23
Onset:2021-02-23
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 1 LA / IM

Administered by: School      Purchased by: ??
Symptoms: Abdominal pain, Acidosis, Activated partial thromboplastin time prolonged, Alanine aminotransferase increased, Angiogram pulmonary abnormal, Angiogram pulmonary normal, Anion gap, Ascites, Aspartate aminotransferase increased, Atelectasis, Bilirubin conjugated, Blood albumin, Blood bicarbonate decreased, Blood bilirubin, Blood creatinine increased, Blood glucose decreased, Blood lactic acid, Blood lactic acid normal, Blood pH decreased, Blood pH increased, Blood potassium decreased, Blood urea increased, Cholelithiasis, Death, Dyspnoea, Enteritis, Fibrin D dimer, Hypoglycaemia, Ileus, International normalised ratio increased, Nausea, PCO2 increased, Pericardial effusion, Platelet count decreased, Pleural effusion, Proctitis, Retching, Vomiting, White blood cell count decreased, Varices oesophageal, Computerised tomogram abdomen abnormal, Blood alkaline phosphatase increased, Troponin, Atypical mycobacterial infection, N-terminal prohormone brain natriuretic peptide increased, Computerised tomogram pelvis abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, metoprolol, simvastatin, acetaminophen, ibuprofen, calcium carbonate, furosemide, diphenoxylate/atropine, magnesium chloride, omeprazole, Carafate, testosterone, vitamin D3, levothyroxine
Current Illness: None
Preexisting Conditions: Colon Cancer Hypothyroidism Hyperlipidemia GERD Hypertension
Allergies: NKDA
Diagnostic Lab Data: 2/23/21: White count is 2.1, platelet 26, INR 1.7, PTT 107.5, D-dimer greater than 5000 pH is 7.03 with PCO2 of 50, potassium 3.3, bicarb of 16, anion gap of 21, BUN of 26, creatinine 2.5, glucose of 39, lactic acid of 14.6, total bilirubin of 4.58, direct bilirubin of 3.87, AST 134, ALT of 43, alk phos of 194. Troponin is negative. proBNP of 4229. Albumin 1.9. CT scan of the abdomen pelvis shows complex fluid attenuation the posterior right hepatic lobe, possibly metastasis, nonspecific hepatic morphology, possibly cirrhosis. Small volume ascites, punctate calcified gallstone with pericholecystic fluid related to ascites. Infiltration of the submucosal fat of the ascending colon. Possible wall thickening of a short segment of jejunum possibly infectious or inflammatory process such as enteritis. Distention of a few loops of jejunum which may represent localized ileus. Fluid within the distal thoracic esophagus which can be seen in reflux. Mild wall thickening of the GE junction with intraluminal nodularity which may represent esophageal varices. Limited evaluation of bladder due to incomplete distention with possible mucosal hyperenhancement. CT angiogram of the chest demonstrates no evidence of pulmonary thromboembolic disease. Small segmental and subsegmental pulmonary emboli cannot be excluded. Distention of the entirety of thoracic esophagus with simple fluid. Trace bilateral pleural effusions. Overlying compressive atelectasis. Small pericardial effusion. Small focal atelectasis or atypical infection in the inferior lingula.
CDC 'Split Type':

Write-up: Abdominal pain, nausea and vomiting, shortness of breath, acidosis, hypoglycemia, death. Onset of abdominal pain was 30 minutes after administration of the vaccine followed by 20+ episodes of vomiting and dry heaving.


Changed on 5/7/2021

VAERS ID: 1051651 Before After
VAERS Form:2
Age:58.0
Sex:Male
Location:New York
Vaccinated:2021-02-23
Onset:2021-02-23
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 1 LA / IM

Administered by: School      Purchased by: ??
Symptoms: Abdominal pain, Acidosis, Activated partial thromboplastin time prolonged, Alanine aminotransferase increased, Angiogram pulmonary abnormal, Angiogram pulmonary normal, Anion gap, Ascites, Aspartate aminotransferase increased, Atelectasis, Bilirubin conjugated, Blood albumin, Blood bicarbonate decreased, Blood bilirubin, Blood creatinine increased, Blood glucose decreased, Blood lactic acid, Blood lactic acid normal, Blood pH decreased, Blood pH increased, Blood potassium decreased, Blood urea increased, Cholelithiasis, Death, Dyspnoea, Enteritis, Fibrin D dimer, Hypoglycaemia, Ileus, International normalised ratio increased, Nausea, PCO2 increased, Pericardial effusion, Platelet count decreased, Pleural effusion, Proctitis, Retching, Vomiting, White blood cell count decreased, Varices oesophageal, Computerised tomogram abdomen abnormal, Blood alkaline phosphatase increased, Troponin, Atypical mycobacterial infection, N-terminal prohormone brain natriuretic peptide increased, Computerised tomogram pelvis abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, metoprolol, simvastatin, acetaminophen, ibuprofen, calcium carbonate, furosemide, diphenoxylate/atropine, magnesium chloride, omeprazole, Carafate, testosterone, vitamin D3, levothyroxine
Current Illness: None
Preexisting Conditions: Colon Cancer Hypothyroidism Hyperlipidemia GERD Hypertension
Allergies: NKDA NKDA
Diagnostic Lab Data: 2/23/21: White count is 2.1, platelet 26, INR 1.7, PTT 107.5, D-dimer greater than 5000 pH is 7.03 with PCO2 of 50, potassium 3.3, bicarb of 16, anion gap of 21, BUN of 26, creatinine 2.5, glucose of 39, lactic acid of 14.6, total bilirubin of 4.58, direct bilirubin of 3.87, AST 134, ALT of 43, alk phos of 194. Troponin is negative. proBNP of 4229. Albumin 1.9. CT scan of the abdomen pelvis shows complex fluid attenuation the posterior right hepatic lobe, possibly metastasis, nonspecific hepatic morphology, possibly cirrhosis. Small volume ascites, punctate calcified gallstone with pericholecystic fluid related to ascites. Infiltration of the submucosal fat of the ascending colon. Possible wall thickening of a short segment of jejunum possibly infectious or inflammatory process such as enteritis. Distention of a few loops of jejunum which may represent localized ileus. Fluid within the distal thoracic esophagus which can be seen in reflux. Mild wall thickening of the GE junction with intraluminal nodularity which may represent esophageal varices. Limited evaluation of bladder due to incomplete distention with possible mucosal hyperenhancement. CT angiogram of the chest demonstrates no evidence of pulmonary thromboembolic disease. Small segmental and subsegmental pulmonary emboli cannot be excluded. Distention of the entirety of thoracic esophagus with simple fluid. Trace bilateral pleural effusions. Overlying compressive atelectasis. Small pericardial effusion. Small focal atelectasis or atypical infection in the inferior lingula.
CDC 'Split Type':

Write-up: Abdominal pain, nausea and vomiting, shortness of breath, acidosis, hypoglycemia, death. Onset of abdominal pain was 30 minutes after administration of the vaccine followed by 20+ episodes of vomiting and dry heaving.


Changed on 5/14/2021

VAERS ID: 1051651 Before After
VAERS Form:2
Age:58.0
Sex:Male
Location:New York
Vaccinated:2021-02-23
Onset:2021-02-23
Submitted:0000-00-00
Entered:2021-02-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 014M20A / 1 LA / IM

Administered by: School      Purchased by: ??
Symptoms: Abdominal pain, Acidosis, Activated partial thromboplastin time prolonged, Alanine aminotransferase increased, Angiogram pulmonary abnormal, Angiogram pulmonary normal, Anion gap, Ascites, Aspartate aminotransferase increased, Atelectasis, Bilirubin conjugated, Blood albumin, Blood bicarbonate decreased, Blood bilirubin, Blood creatinine increased, Blood glucose decreased, Blood lactic acid, Blood lactic acid normal, Blood pH decreased, Blood pH increased, Blood potassium decreased, Blood urea increased, Cholelithiasis, Death, Dyspnoea, Enteritis, Fibrin D dimer, Hypoglycaemia, Ileus, International normalised ratio increased, Nausea, PCO2 increased, Pericardial effusion, Platelet count decreased, Pleural effusion, Proctitis, Retching, Vomiting, White blood cell count decreased, Varices oesophageal, Computerised tomogram abdomen abnormal, Blood alkaline phosphatase increased, Troponin, Atypical mycobacterial infection, N-terminal prohormone brain natriuretic peptide increased, Computerised tomogram pelvis abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-24
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril, metoprolol, simvastatin, acetaminophen, ibuprofen, calcium carbonate, furosemide, diphenoxylate/atropine, magnesium chloride, omeprazole, Carafate, testosterone, vitamin D3, levothyroxine
Current Illness: None
Preexisting Conditions: Colon Cancer Hypothyroidism Hyperlipidemia GERD Hypertension
Allergies: NKDA NKDA
Diagnostic Lab Data: 2/23/21: White count is 2.1, platelet 26, INR 1.7, PTT 107.5, D-dimer greater than 5000 pH is 7.03 with PCO2 of 50, potassium 3.3, bicarb of 16, anion gap of 21, BUN of 26, creatinine 2.5, glucose of 39, lactic acid of 14.6, total bilirubin of 4.58, direct bilirubin of 3.87, AST 134, ALT of 43, alk phos of 194. Troponin is negative. proBNP of 4229. Albumin 1.9. CT scan of the abdomen pelvis shows complex fluid attenuation the posterior right hepatic lobe, possibly metastasis, nonspecific hepatic morphology, possibly cirrhosis. Small volume ascites, punctate calcified gallstone with pericholecystic fluid related to ascites. Infiltration of the submucosal fat of the ascending colon. Possible wall thickening of a short segment of jejunum possibly infectious or inflammatory process such as enteritis. Distention of a few loops of jejunum which may represent localized ileus. Fluid within the distal thoracic esophagus which can be seen in reflux. Mild wall thickening of the GE junction with intraluminal nodularity which may represent esophageal varices. Limited evaluation of bladder due to incomplete distention with possible mucosal hyperenhancement. CT angiogram of the chest demonstrates no evidence of pulmonary thromboembolic disease. Small segmental and subsegmental pulmonary emboli cannot be excluded. Distention of the entirety of thoracic esophagus with simple fluid. Trace bilateral pleural effusions. Overlying compressive atelectasis. Small pericardial effusion. Small focal atelectasis or atypical infection in the inferior lingula.
CDC 'Split Type':

Write-up: Abdominal pain, nausea and vomiting, shortness of breath, acidosis, hypoglycemia, death. Onset of abdominal pain was 30 minutes after administration of the vaccine followed by 20+ episodes of vomiting and dry heaving.

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