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From the 4/30/2021 release of VAERS data:

This is VAERS ID 1130449



Case Details

VAERS ID: 1130449 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-03-09
Onset:2021-03-24
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 - / IM

Administered by: Other       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Amylase decreased, Aspartate aminotransferase normal, Basophil count decreased, Basophil percentage, Bilirubin urine, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium decreased, Blood chloride normal, Blood creatine phosphokinase MB normal, Blood creatine phosphokinase normal, Blood creatinine normal, Blood glucose normal, Blood magnesium normal, Blood potassium normal, Blood sodium normal, Blood urea normal, Blood urine present, Brain natriuretic peptide increased, Bronchiectasis, Carbon dioxide decreased, Chest discomfort, Chromaturia, Computerised tomogram thorax, Cough, Drug screen negative, Dyspnoea, Eosinophil count decreased, Eosinophil percentage, Eructation, Fibrin D dimer normal, Gastrooesophageal reflux disease, Glomerular filtration rate normal, Glucose urine absent, Haematocrit normal, Haemoglobin normal, Haemoptysis, Influenza virus test negative, Lipase normal, Lung opacity, Lymphocyte count normal, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume increased, Monocyte count normal, Monocyte percentage increased, Neutrophil count increased, Neutrophil percentage, Nitrite urine absent, Palpitations, Platelet count normal, Protein total normal, Protein urine absent, Red blood cell count normal, Red blood cells urine, SARS-CoV-2 test, Scan with contrast abnormal, Specific gravity urine, Troponin I increased, Urinary sediment present, Urine ketone body absent, Urine leukocyte esterase, Urobilinogen urine increased, White blood cell count increased, pH urine normal
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Haematopoietic leukopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific dysfunction (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Current Outpatient Medications: ? aspirin 81 MG EC tablet, Take 81 mg by mouth Nightly, Disp: , Rfl: ? atorvaSTATin (LIPITOR) 20 MG tablet, Take 20 mg by mouth Nightly, Disp: , Rfl: ? gabapentin (NEURONTIN) 300 MG capsule, Take 1,200 mg by
Current Illness:
Preexisting Conditions:
Allergies: nka
Diagnostic Lab Data: CTA Chest For Pulmonary Embolism w Contrast [245598176] Collected: 03/23/21 0139 Order Status: Completed Updated: 03/23/21 0215 Narrative: EXAM DESCRIPTION: CT CHEST ANGIOGRAPHY WITH IV CONTRAST CLINICAL INFORMATION: Age: 58 years Gender: Male Indication: Shortness of breath Additional history: Hemoptysis COMPARISON: None. TECHNIQUE: Procedure: CT Angiography of the Chest Protocol: Pulmonary embolus Reformats: Coronal and sagittal Intravenous Contrast: 80 mL Omnipaque 300 without documented adverse reaction Image Quality: Adequate Multiple coronal computer generated 3D reconstructions (MIPS) of the pulmonary arteries were included. This exam was performed according to our departmental dose optimization program, which includes automated exposure control, adjustment of the mA and/or kV according to patient size and/or use of iterative reconstruction technique. Dose Range: Up-to-date CT equipment and radiation dose reduction techniques were employed. FINDINGS: Pulmonary arteries: No pulmonary embolus Lungs and pleura: Mild right basilar groundglass airspace opacities and mild bronchiectasis is seen.. Heart: Normal heart size. No pericardial effusion . Aorta: Normal Mediastinum and hila: Normal Chest wall: Normal Lower neck: Normal IMPRESSION: Negative for pulmonary embolus. Mild right basilar bronchiectasis and mild groundglass airspace opacities which may represent atypical infection versus pulmonary contusion in the setting of trauma. Electronically signed by: MD 3/23/2021 2:13 AM CDT Influenza antigen [245598168] Collected: 03/23/21 0149 Order Status: Completed Specimen: Nasopharyngeal Updated: 03/23/21 0214 Influenza A NEGATIVE NEGATIVE Influenza B NEGATIVE NEGATIVE NOVEL CORONAVIRUS SARS-COV-2 BY PCR [245598178] Collected: 03/23/21 0150 Order Status: Sent Specimen: Nasopharyngeal Updated: 03/23/21 0200 Urine Drug Screen Medical - 10 Panel [245598187] Collected: 03/23/21 0118 Order Status: Completed Specimen: Urine Updated: 03/23/21 0143 Amphetamines Screen, Urine NEGATIVE NEGATIVE Barbiturate Screen, Urine NEGATIVE NEGATIVE Benzodiazepine Screen, Urine NEGATIVE NEGATIVE Cocaine Metabolites Urine NEGATIVE NEGATIVE Methamphetamine, UR NEGATIVE NEGATIVE Methadone Screen, Urine NEGATIVE NEGATIVE Opiate Screen, Urine NEGATIVE NEGATIVE Oxycodone Scr Qual,UR NEGATIVE NEGATIVE Phencyclidine Screen Urine NEGATIVE NEGATIVE Propoxyphene NEGATIVE NEGATIVE THC NEGATIVE NEGATIVE TCA - Tricyclic Antidepressants Urine, Qualitative NEGATIVE NEGATIVE Urinalysis with reflex to culture, if indicated [245598186] (Abnormal) Collected: 03/23/21 0119 Order Status: Completed Specimen: URINE,CLEAN CATCH (CCMS) Updated: 03/23/21 0139 Glucose UA NEGATIVE NEGATIVE MG/DL Protein UA NEGATIVE NEGATIVE MG/DL Bilirubin UA NEGATIVE NEGATIVE Urobilinogen UA 0.2 0.2 - 1.0 MG/DL pH UA 5.0 5.0 - 8.0 Blood UA TRACEAbnormal NEGATIVE Ketones UA NEGATIVE NEGATIVE MG/DL Nitrite UA NEGATIVE NEGATIVE Leukocyte Esterase UA NEGATIVE NEGATIVE UR Appearance CLEAR CLEAR Specific Gravity UA <1.006 1.000 - 1.030 Color YELLOW YELLOW Site CCMS Comment, Urine Culture NOT INDICATED RBC Urine 0 to 5 <3 /HPF WBC Urine 0 to 5 <5 /HPF Squamous Epithelial RARE <5 /HPF D-dimer, quantitative [245598173] Collected: 03/23/21 0101 Order Status: Completed Specimen: Blood Updated: 03/23/21 0137 D-Dimer 244 0 - 400 NG/ML FEU Brain Natriuretic Peptide (BNP) [245598172] (Abnormal) Collected: 03/23/21 0101 Order Status: Completed Specimen: Blood Updated: 03/23/21 0137 B-Type Natriuretic Peptide 110High 0 - 100 PG/ML Magnesium [245598167] (Abnormal) Collected: 03/23/21 0101 Order Status: Completed Specimen: Blood Updated: 03/23/21 0136 Magnesium 1.7Low 1.8 - 2.4 MG/DL CKMB [245598170] Collected: 03/23/21 0101 Order Status: Completed Specimen: Blood Updated: 03/23/21 0136 Creatine Kinase-MB 1.7 0.0 - 3.6 NG/ML Troponin Series [245598171] Collected: 03/23/21 0101 Order Status: Completed Specimen: Blood Updated: 03/23/21 0136 Troponin I 0.03 0.00 - 0.06 ng/mL Comment: 0.1 to 0.5 ng/mL shows an increased risk of AMI. 0.6 to 1.5 or greater is suggestive of AMI. Comprehensive metabolic panel [245598164] (Abnormal) Collected: 03/23/21 0101 Order Status: Completed Specimen: Blood Updated: 03/23/21 0136 Glucose 136High 65 - 100 MG/DL Blood Urea Nitrogen 13 7 - 18 MG/DL Creatinine 0.9 0.7 - 1.3 MG/DL Sodium 138 136 - 145 MMOL/L Potassium 3.9 3.5 - 5.1 MMOL/L Chloride 100 98 - 107 MMOL/L Co2 21 21 - 32 MMOL/L Calcium 8.5 8.5 - 10.1 MG/DL Protein Total 7.6 6.4 - 8.2 G/DL Albumin 4.0 3.4 - 5.0 G/DL A/G Ratio 1.1 0.8 - 2.0 Alkaline Phosphatase 64 46 - 116 U/L Alt (SGPT) 43 16 - 63 U/L AST(SGOT) 21 15 - 37 U/L Bilirubin, Total 0.5 0.2 - 1.0 MG/DL GFR Comment IF PATIENT IS AFRICAN AMERICAN, MULTIPLY RESULT BY 1.16 Est GFR $g90 $g90 ML/MIN/1.73sq.m Amylase [245598165] Collected: 03/23/21 0101 Order Status: Completed Specimen: Blood Updated: 03/23/21 0136 Amylase 40 25 - 115 U/L Lipase [245598166] Collected: 03/23/21 0101 Order Status: Completed Specimen: Blood Updated: 03/23/21 0136 Lipase 92 73 - 393 U/L CK (CPK) Creatine Phosphokinase [245598169] Collected: 03/23/21 0101 Order Status: Completed Specimen: Blood Updated: 03/23/21 0136 Creatine Kinase Total 124 39 - 308 U/L CBC w Auto Diff [245598163] (Abnormal) Collected: 03/23/21 0101 Order Status: Completed Specimen: Blood Updated: 03/23/21 0117 White Blood Cell Count 11.7High 4.8 - 9.6 THOUS/uL Red Blood Cell Count 5.18 4.33 - 5.59 MIL/uL Hemoglobin 15.6 13.1 - 16.8 GM/DL Hematocrit 46.0 38.8 - 49.0 % Mean Corpuscular Volume 88.8 82.7 - 94.4 FL Mean Corpuscular Hemoglobin 30.1 27.7 - 32.6 PG Mean Corpuscular Hemoglobin Conc 33.9 32.4 - 35.7 G/DL Rdwcv 12.9 11.6 - 13.9 % Rdwsd 42.5 36.0 - 46.1 FL Platelet Count 198 154 - 364 THOUS/uL Mean Platelet Volume 11.4 8.7 - 11.7 FL Nucleated Red Blood Cells 0.0 0.0 /100 WBC''S Abs NRBC 0.0 0.0 THOUS/uL Differential Type AUTO Neutrophils 68.8High 34.0 - 67.9 % Lymphs 18.0Low 19.1 - 41.2 % Monocytes 10.0 6.1 - 12.3 % Eos 1.7 0.9 - 7.6 % Basos 0.9 0.2 - 1.5 % Neutrophils Absolute Count 8.1High 2.7 - 5.8 THOUS/uL Lymphocytes Absolute Count 2.1 1.1 - 3.3 THOUS/uL Monocytes Absolute Count 1.2High 0.4 - 0.9 THOUS/uL Eosinophils Absolute Count 0.2 0.1 - 0.6 THOUS/uL Basophils Absolute Count 0.1 0.0 - 0.1 THOUS/uL Imm Gran 0.6 0.2 - 0.9 % Abs Imm Gran 0.07 0.0 - 0.1 THOUS/uL
CDC Split Type:

Write-up: 3/24/21 ER HPI: 58 y.o. male who presents with shortness of breath, palpitations, chest pressure, and hemoptysis. Patient has known history of atrial fibrillation and coronary artery disease. Patient reports he was out in his yard approximately 1 hour ago this evening picking up some items when he bent over and started feeling palpitations. Patient states the palpitations caused a pressure in the center of his chest. He then became short of breath. He then states he got into a coughing fit and coughed up some blood. Patient states he knew something was not right so he told his wife to bring him to the ER. Currently here in ER patient continues to complain of palpitations and trash pressure. Patient currently gives his pain as 6/10. It is nonradiating. Patient reports shortness of breath but denies any lightheadedness, dizziness, nausea, vomiting, or diaphoresis. Of note, patient reports he has been having acid reflux and belching tonight. He states his wife had given him two Pepcid earlier.


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