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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1101991

Case Details

VAERS ID: 1101991 (history)  
Form: Version 2.0  
Age: 97.0  
Sex: Female  
Location: New York  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: ?
Symptoms: Abnormal behaviour, Atrial fibrillation, Blood thyroid stimulating hormone normal, Breath sounds absent, COVID-19, Chest X-ray normal, Coagulation test normal, Cough, Death, Dehydration, Delirium, Dementia, Diet refusal, Disorientation, Dysphagia, Electrocardiogram abnormal, Essential hypertension, Fall, Fibrin D dimer, Full blood count normal, General physical health deterioration, Haemoptysis, Hypersomnia, Hypophagia, Leukocytosis, Metabolic function test normal, Pulse absent, Pupillary light reflex tests abnormal, Pupillary reflex impaired, Respiratory disorder, SARS-CoV-2 test positive, Screaming, Tachycardia, Tachypnoea, Thyroxine free normal, Troponin I normal, Unresponsive to stimuli, Urine analysis normal, Urine output decreased, Ventilation/perfusion scan
SMQs:, Acute renal failure (broad), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Dementia (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (narrow), Psychosis and psychotic disorders (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hostility/aggression (broad), Glaucoma (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Retinal disorders (narrow), Depression (excl suicide and self injury) (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-08
   Days after onset: 11
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) cholecalciferol (VITAMIN D3) 1000 UNITS capsule desoximetasone (TOPICORT) 0.25 % cream digoxin (LANOXIN) 125 MCG tablet divalproex (DEPAKOTE) 250 MG EC tablet furosemide (LASIX) 40 MG tablet metoprolol succinat
Current Illness: Abnormal behavior
Preexisting Conditions: Arthritis Atrial fibrillation Hypertension Dementia without behavioral disturbance Recurrent falls Cholecystectomy
Allergies: None known
Diagnostic Lab Data: 2/25 -CMP and CBC on admission WNL and nonactionable -POC troponin I negative x1 -Coags WNL -TSH and free T4 WNL -UA without signs of infection -CXR shows stable exam without evidence of acute disease -EKG showing A fib and and nonspecific ST abnormality likely digitalis effect 2/26 COVID positive (NP swab - 2019 nCoV Amplified --THIS ASSAY AMPLIFIES AND DETECTS THE TARGET RNA USING ISOTHERMAL HELICASE DEPENDENT AMPLIFICATION. TESTING PERFORMED ON THE SOLANA.) 2/27 D-dimer sensitive 1.51 (normal range < 0.5mg/L) 2/28 ? chest Xray - No acute findings. In general, a similar appearance was noted 3 days ago and 1 year ago. 2/28 - NM LUNG SCAN PERFUSION PARTICULATE - Low probability of pulmonary embolism.
CDC Split Type:

Write-up: In ED on 2/25/21 Chief complaint: Patient''s daughter present at bedside stating patient was not vocalizing this morning when she woke up. Patient''s daughter was talking to her and she would orient to her but not answer any of her questions. EMS called and by the time they arrived patient was acting her normal self. Daughter states she has had a very difficult time managing patient''s behaviors over the last several weeks and it has been getting more difficult. Daughter states that over the last several weeks her behaviors have been worsening and been more difficult to deal with. These include her getting up at night and sundowning as well as yelling and screaming during the day. Daughter states that she gets in the shouting matches with the patient during the day. Daughter breaks down and starts to cry when discussing that she thinks her mother will need long-term placement as she is having a difficult time dealing with her behaviors. Of note patient did receive second dose of Covid vaccine yesterday. -Patient has not been complaining of any symptoms over the last several days and daughter has not noticed cough or congestion or other signs of URI/illness -No focal neurologic deficits on exam -Received 1L IV NS in ED 2/26/21 Covid positive, incidental finding ? tested so she could go to nursing facility -Patient asymptomatic -Vital signs stable, afebrile -She does not need treatment at this time -She will need a repeat Covid test 14 days after the original Covid test prior to going to SNF -Plan- discharge to skilled nursing facility Discharge summary Principal Problem: Comfort measures only status Active Problems: Chronic atrial fibrillation Essential hypertension Dementia with behavioral disturbance Recurrent falls Dysphagia COVID-19 Resolved Problems: Cough with hemoptysis Leukocytosis Dehydration Inadequate oral intake Patient is a 97-year-old female with a past medical history of dementia, likely combined vascular/Alzheimer''s, hypertension, chronic A. Fib, who presented to the ED on 2/25/2021 due to behavioral disturbance as well as need for long-term care placement due to progressive dementia. She did have an incidental positive Covid test on 2/26/2021 and was planned for discharge to COVID recovery ward of SNF. She did not require medication or oxygen treatment for COIVD-19. She developed tachycardia/tachypnea and cough later productive for blood after suctioning attempts overnight on 2/28-3/1, which did not recur. Unfortunately, patient''s overall function declined after, and she was refusing/unable to eat or drink. She was transitioned to comfort care status on 03/03/2021. She eventually slipped into persistent sleep with lack of responsiveness on 3/4/2021. Comfort care was provided. She had decreased urinary utput and respiratory function indicating expected progression. She was noted to not have a heart rate on 03/08/2021. Auscultation did not reveal any breath sounds or heart sounds; unable to palpate pulse; no pupillary response to light was seen; and patient did not respond to painful stimuli. Death was pronounced on 03/08/2021, 02:58am. Deceased 3/8/21

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