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This is VAERS ID 1186600

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1186600
VAERS Form:2
Age:62.0
Sex:Female
Location:Foreign
Vaccinated:2021-04-04
Onset:2021-04-05
Submitted:0000-00-00
Entered:2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 AR / SYR

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain, Abdominal tenderness, Acidosis, Acute myocardial infarction, Agitation, Angiogram pulmonary normal, Anxiety, Arteriogram coronary abnormal, Aspartate aminotransferase increased, Asthenia, Blood bicarbonate decreased, Blood calcium decreased, Blood creatine phosphokinase increased, Blood lactic acid, Blood pH decreased, Blood sodium decreased, Blood urea increased, Cachexia, Carbon dioxide decreased, Cardiac arrest, Cardiac failure congestive, Cardiac murmur, Cardio-respiratory arrest, Cardiogenic shock, Catheterisation cardiac abnormal, Confusional state, Coronary artery disease, Cyanosis, Dry skin, Dyspnoea, Ecchymosis, Echocardiogram, Electrocardiogram abnormal, Essential thrombocythaemia, Fatigue, Haematocrit increased, Haemoglobin increased, Hypokinesia, Hypotension, Intensive care, International normalised ratio normal, Lymphocyte count increased, Malaise, Nausea, Pain, Pallor, Pericardial effusion, Pneumonia, Sepsis, Septic shock, Sinus tachycardia, Speech disorder developmental, Tachycardia, Unresponsive to stimuli, Vomiting, White blood cell count increased, Emotional distress, Platelet count increased, Thoracic operation, Intra-aortic balloon placement, Computerised tomogram abdomen, Pulmonary mass, Troponin increased, General physical condition abnormal, Jugular vein distension, Liver function test normal, Decreased appetite, Echocardiogram abnormal, Endotracheal intubation, Body temperature normal, Multiple organ dysfunction syndrome, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-09
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown. Recent travel history
Preexisting Conditions: HPI: hx of melanoma s/p immunotherapy 2 years ago, chronic thrombocytosis with 7-8 year history on agrelid, followed by Dr.
Allergies: No known allergies
Diagnostic Lab Data: 4/8/21: CTA in all lung fields, no hypoxia or tachypnea on room air. Non tender in all quadrants, no peritoneal signs. No pedal edema or tenderness bilaterally. CTA was negative for PE, revealed multiple pulmonary nodules largest measuring 1 cm in the left upper lobe and additional nodules 0.9 cm in the lateral right middle lobe and 0.9 cm in the inferior lingula. 0.9 nodule in the inferior linear surrounding tree in bud opacity suggestive of atypical infectious process. EKG 4/8/21 at 0113 Rate: 121, Rhythm: sinus tachycardia, no ST elevation. QTC 462, QRS 72. Repeat EKG read at 0341 Rate: 124, Rhythm: sinus tachycardia, no ST elevation, unchagned from prior. Labs at 0120 - Hgb (18.5), Hct (56.9), Plt (940), Immgrans (1.7), Lympohcytes (4.4); Na (132), CO2 (20), BUN (32.0), Createnine GFR (1.12), EGFR (49), Calcium (8.6). LFTs normal except AST (59). INR 1.1, CPK (1,109), Troponin (4.7) Blood work with elevated troponin (4.7 at 0120, 6.272 at 0755), no STEMI criteria, never with CP or SOB evaluated by cardiology , started on DAPT and heparin , CTPA obtained due to high risk factors for PE with melanoma in the past, recent travel and possible adverse reaction/cogulopathy with vaccine, no PE possible infectious/malignant features in lungs. Blood work also with elevated WBC (22.88 at 0532) and lactic acid (7.8 at 0604; 8.5 at 0755), negative beta hydroxy but with a very low ph, tox screen positive for opiates / tylenol/aspirin levels unremarkable. CPK 1,781 at 0830. SARS coronavirus-2 RNA (COVID-19) test negative at 0212. Labs at 0830 - WBC (30.30), Hgb (17.5), Hct (54.4), Plt (884), Na (136), CO2 (14.3), BUN (33.4), Createnine GFR (1.05), Calcium (7.7), CPK (1,781), Troponin (3.973, 4.031) Echo at 0846 - depress EF between 30-40%, with pericardial fluids, possible pericardial tamponade. At 0900 - ordered CTA chest/abd/pelvis for aortic dissection, the risk of CIN was considered but the benefit outweigh the complication. 4/8/21 at 1040 - Perioperative anesthesia eval: 1) Emergent insertion of peripheral percutaneous venous and arterial ECMO cannulae 2) Emergent initiation of veno-arterial extracorporeal membrane oxygenation support 3) Emergent insertion of distal perfusion cannula 4) Ultrasound guided vascular access 5) Lower extremity angiograms 6) Transthoracic and/or transesophageal echocardiogram(s) 7) Left heart catheterization with coronary angiography LHC showed Non obstructive CAD, LVEDP 37 mmHg (Elevated left sided filling pressures) and RHC showed PA pressure 36/30 mmHg, mean 33mmHg; Sat mixed venous 79%, Ao 98%; CO Fick 5.1, CI 3.26. Pertinent Lab Prior to or at Onset of Code: pH 7.12/31/133/10.1/95%
CDC 'Split Type':

Write-up: ED note: 62 year old patient presented to Main ED on 4/8/21 at 0120. Patient arrived by ambulance and her chief complaint was left sided abdominal pain associated with generalized weakness, malaise, and fatigue x 3 days. HPI: hx of melanoma s/p immunotherapy 2 years ago, chronic thrombocytosis with 7-8 year history on agrelid, followed by Dr. Patient travelled recently. She received her Johnson and Johnson Covid vaccine Sunday afternoon (4/4). The next day she started to feel unwell with malaise, generalized weakness and body aches. with subjective fevers on Monday (4/5), nausea and 1 episode of non bilious vomiting. She refers severe pain that did not improved with ibuprofen, as well as increased fatigue, anorexia and has been unable to drink or eat any food for the past couple of days. As per her husband she also developed SOB with exertion yesterday. No fever, chills, constipation, diarrhea, blurred vision, numbness or paresthesias. Travel 4 days prior and receiving johnson and johnson covid vaccine. No modifying factors. No urinary sx, cough, no sick contacts. Pt denies measured fevers, chills, diarrhea, chest pain, SOB, blood in stool, headache, vision changes, numbness/tingling, focal weakness. No prior hx of MI / PE, no history of similar pain , no abdominal surgeries. PMHx: melanoma, thrombocytosis ; PSHx: none ; Social Hx: (-) tobacco, (-) EtOH, (-) illicit drug use ; Allergies: none ; PCP: in another country NKDA. Family history: Mother CKD. Social history: she is married, originally from another country; has been living in another location for the last 3 months. She is an architect Denies any sick contacts. Her husband has been vaccinated for COVID-19.Travel screening done in the ED: no/unsure if in the last month she may have been in contact with someone who was confirmed or suspected to have COVID-19. Yes (negative result) to "have you had a COVID-19 viral test in the last 14 days. No to "do you have any of the following new or worsening symptoms?" and no to have you traveled internationally in the last month? No documented travel since 03/08/21. No to all high risk personnel screen questions. Physical Exam on 4/8/21 at 0128am: BP 110/58 | Pulse 120 | Temp 97 ?F (36.1 ?C) | Resp (!) 34 | Ht 5'' 2.99" (1.6 m) | Wt 125 lb 10.6 oz (57 kg) | SpO2 97% | BMI 22.27 kg/m? Normal PE in ED: Constitutional: She is oriented to person, place, and time. She appears well , well-developed, well-nourished and appears stated age. Non-toxc appearing, no nystagmus or gaze deviation, no meningismus or rigidity, 2+ equal pulses in all extremities, tachycardic, regular. Code sepsis called at 0250. At 0951 - Dr.at bedside will take patient to the OR for possibly VA ECMO for ischemic cardiomyoptahy. Medications: ASA, brilinta and heparin drip. Started on cefepime, vancomycin and azithromycin (D1) for suspected multifocal pneumonia Patient became hypotensive in the course of the morning and was transferred to the cath lab for urgent cardiac catheterization that showed non-obstructive CAD, elevated filling pressures, normal CO (on levophed). Echo showed LVEF 29%, biventricular failure, global hypokinesis. No valve disease 4/8/21 at 1012 - Cardiothoracic Surgery: Physical Exam positive for: Constitutional: She appears well-developed and well-nourished. She appears toxic. She has a sickly appearance. She appears ill. She appears distressed. Nasal cannula in place. Neck: Normal range of motion. Neck supple. JVD present. Cardiovascular: Regular rhythm. Tachycardia present. Murmur heard. Systolic murmur is present with a grade of 2/6. Pulmonary/Chest: Effort normal. No respiratory distress. She has rales. Abdominal: Soft. She exhibits no distension. There is abdominal tenderness. There is no rebound and no guarding. Neurological: She is alert. She has normal strength. A sensory deficit is present. Skin: Skin is dry and intact. Ecchymosis noted. She is not diaphoretic. There is cyanosis. There is pallor. Psychiatric: Judgment and thought content normal. Her mood appears anxious. Her speech is delayed. She is agitated. Cognition and memory are normal. Assessment: 1) Cardiogenic shock -discussed extensively with patient and husband high likelihood for need for V-A ECMO support 2) NSTEMI -f/u LHC to eval for CAD 3) Essential thrombocytosis - rec heme consult as plts significantly elevated and high risk of thrombus/embolism development 4) Pericardial effusion - rpt echo in AM but no indication for intervention at this time as no evidence of tamponade physiology by echo 4/8/21 at 1230 - Cardiothoracic surgery note: Patient evaluated at bedside with cardiology at time of cardiac cath with decision for no ECMO support as per cardiology recs secondary to shock not thought to be cardiogenic primary in nature with further management as per MICU. 4/8/21 at 1254 - Coronary Care Unit note: CTA abdomen and pelvis showed no acute aortic disease, no ischemic bowel, small linear filling defect in proximal celiac trunk may represent nonocclusive thrombus, stable small mildly hyperdense pericardial effusion. She was taken to the OR for cath and possible ECMO. Found to be agitated and confused. She was intubated in the OR and pressors were started (Levophed and epinephrine). IABP placed during cath, but removed due to good cardiac function. No coronary artery disease on cath. RIJ Swan Ganz placed. During the course of hours WBC increased to 30 and then to 45. Her pressors requirements increased and the acid base status woresened, with depleted bicarb and low pH. Currently on broad spectrum ATB (cefepime, Vancomycin and azithromycin) with infusion of flis and albumin, bicarb pushes (2) and gtt, on Levophed and vasopressin. Currently on broad spectrum ATB (cefepime, Vancomycin and azithromycin) with infusion of IVF and albumin, bicarb pushes (2) and gtt, on Levophed and vasopressin. 4/8/21 at 2127 - Surgery note: We are consulted due to concern for bowel ischemia. The patient is on max dose of Levo, Vaso, Epi with refractory hypotension and acidosis. Her CT shows all mesenteric vessels are patent and no bowel thickening, stranding, or free fluid to suggest bowel ischemia. The abdomen is soft non tender and non distended. In the setting of multiorgan failure and low flow state, non occlusive mesenteric ischemia would be expected but would be diffuse in nature rather than focal. There is no role for surgical resection for diffuse bowel ischemia if it develops--the mainstay of treatment being to improve her overall perfusion to vital organs. She may benefit from ionotropic support in addition to vasopressors. Code Blue called 4/9/2021 at 0045 ? patient found unresponsive, asystole. History: 62 y.o female history of ET, melanoma s/p surgical removal and immunotherapy, presented with septic shock with metabolic acidosis, intubated, sedated on pressors, levophed, epinephrine and vasopressin drip. Pertinent Lab Prior to or at Onset of Code: pH 7.12/31/133/10.1/95%


Changed on 5/7/2021

VAERS ID: 1186600 Before After
VAERS Form:2
Age:62.0
Sex:Female
Location:Foreign
Vaccinated:2021-04-04
Onset:2021-04-05
Submitted:0000-00-00
Entered:2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 AR / SYR

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain, Abdominal tenderness, Acidosis, Acute myocardial infarction, Agitation, Angiogram pulmonary normal, Anxiety, Arteriogram coronary abnormal, Aspartate aminotransferase increased, Asthenia, Blood bicarbonate decreased, Blood calcium decreased, Blood creatine phosphokinase increased, Blood lactic acid, Blood pH decreased, Blood sodium decreased, Blood urea increased, Cachexia, Carbon dioxide decreased, Cardiac arrest, Cardiac failure congestive, Cardiac murmur, Cardio-respiratory arrest, Cardiogenic shock, Catheterisation cardiac abnormal, Confusional state, Coronary artery disease, Cyanosis, Dry skin, Dyspnoea, Ecchymosis, Echocardiogram, Electrocardiogram abnormal, Essential thrombocythaemia, Fatigue, Haematocrit increased, Haemoglobin increased, Hypokinesia, Hypotension, Intensive care, International normalised ratio normal, Lymphocyte count increased, Malaise, Nausea, Pain, Pallor, Pericardial effusion, Pneumonia, Sepsis, Septic shock, Sinus tachycardia, Speech disorder developmental, Tachycardia, Unresponsive to stimuli, Vomiting, White blood cell count increased, Emotional distress, Platelet count increased, Thoracic operation, Intra-aortic balloon placement, Computerised tomogram abdomen, Pulmonary mass, Troponin increased, General physical condition abnormal, Jugular vein distension, Liver function test normal, Decreased appetite, Echocardiogram abnormal, Endotracheal intubation, Body temperature normal, Multiple organ dysfunction syndrome, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-09
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown. Recent travel history
Preexisting Conditions: HPI: hx of melanoma s/p immunotherapy 2 years ago, chronic thrombocytosis with 7-8 year history on agrelid, followed by Dr.
Allergies: No known allergies allergies
Diagnostic Lab Data: 4/8/21: CTA in all lung fields, no hypoxia or tachypnea on room air. Non tender in all quadrants, no peritoneal signs. No pedal edema or tenderness bilaterally. CTA was negative for PE, revealed multiple pulmonary nodules largest measuring 1 cm in the left upper lobe and additional nodules 0.9 cm in the lateral right middle lobe and 0.9 cm in the inferior lingula. 0.9 nodule in the inferior linear surrounding tree in bud opacity suggestive of atypical infectious process. EKG 4/8/21 at 0113 Rate: 121, Rhythm: sinus tachycardia, no ST elevation. QTC 462, QRS 72. Repeat EKG read at 0341 Rate: 124, Rhythm: sinus tachycardia, no ST elevation, unchagned from prior. Labs at 0120 - Hgb (18.5), Hct (56.9), Plt (940), Immgrans (1.7), Lympohcytes (4.4); Na (132), CO2 (20), BUN (32.0), Createnine GFR (1.12), EGFR (49), Calcium (8.6). LFTs normal except AST (59). INR 1.1, CPK (1,109), Troponin (4.7) Blood work with elevated troponin (4.7 at 0120, 6.272 at 0755), no STEMI criteria, never with CP or SOB evaluated by cardiology , started on DAPT and heparin , CTPA obtained due to high risk factors for PE with melanoma in the past, recent travel and possible adverse reaction/cogulopathy with vaccine, no PE possible infectious/malignant features in lungs. Blood work also with elevated WBC (22.88 at 0532) and lactic acid (7.8 at 0604; 8.5 at 0755), negative beta hydroxy but with a very low ph, tox screen positive for opiates / tylenol/aspirin levels unremarkable. CPK 1,781 at 0830. SARS coronavirus-2 RNA (COVID-19) test negative at 0212. Labs at 0830 - WBC (30.30), Hgb (17.5), Hct (54.4), Plt (884), Na (136), CO2 (14.3), BUN (33.4), Createnine GFR (1.05), Calcium (7.7), CPK (1,781), Troponin (3.973, 4.031) Echo at 0846 - depress EF between 30-40%, with pericardial fluids, possible pericardial tamponade. At 0900 - ordered CTA chest/abd/pelvis for aortic dissection, the risk of CIN was considered but the benefit outweigh the complication. 4/8/21 at 1040 - Perioperative anesthesia eval: 1) Emergent insertion of peripheral percutaneous venous and arterial ECMO cannulae 2) Emergent initiation of veno-arterial extracorporeal membrane oxygenation support 3) Emergent insertion of distal perfusion cannula 4) Ultrasound guided vascular access 5) Lower extremity angiograms 6) Transthoracic and/or transesophageal echocardiogram(s) 7) Left heart catheterization with coronary angiography LHC showed Non obstructive CAD, LVEDP 37 mmHg (Elevated left sided filling pressures) and RHC showed PA pressure 36/30 mmHg, mean 33mmHg; Sat mixed venous 79%, Ao 98%; CO Fick 5.1, CI 3.26. Pertinent Lab Prior to or at Onset of Code: pH 7.12/31/133/10.1/95%
CDC 'Split Type':

Write-up: ED note: 62 year old patient presented to Main ED on 4/8/21 at 0120. Patient arrived by ambulance and her chief complaint was left sided abdominal pain associated with generalized weakness, malaise, and fatigue x 3 days. HPI: hx of melanoma s/p immunotherapy 2 years ago, chronic thrombocytosis with 7-8 year history on agrelid, followed by Dr. Patient travelled recently. She received her Johnson and Johnson Covid vaccine Sunday afternoon (4/4). The next day she started to feel unwell with malaise, generalized weakness and body aches. with subjective fevers on Monday (4/5), nausea and 1 episode of non bilious vomiting. She refers severe pain that did not improved with ibuprofen, as well as increased fatigue, anorexia and has been unable to drink or eat any food for the past couple of days. As per her husband she also developed SOB with exertion yesterday. No fever, chills, constipation, diarrhea, blurred vision, numbness or paresthesias. Travel 4 days prior and receiving johnson and johnson covid vaccine. No modifying factors. No urinary sx, cough, no sick contacts. Pt denies measured fevers, chills, diarrhea, chest pain, SOB, blood in stool, headache, vision changes, numbness/tingling, focal weakness. No prior hx of MI / PE, no history of similar pain , no abdominal surgeries. PMHx: melanoma, thrombocytosis ; PSHx: none ; Social Hx: (-) tobacco, (-) EtOH, (-) illicit drug use ; Allergies: none ; PCP: in another country NKDA. Family history: Mother CKD. Social history: she is married, originally from another country; has been living in another location for the last 3 months. She is an architect Denies any sick contacts. Her husband has been vaccinated for COVID-19.Travel screening done in the ED: no/unsure if in the last month she may have been in contact with someone who was confirmed or suspected to have COVID-19. Yes (negative result) to "have you had a COVID-19 viral test in the last 14 days. No to "do you have any of the following new or worsening symptoms?" and no to have you traveled internationally in the last month? No documented travel since 03/08/21. No to all high risk personnel screen questions. Physical Exam on 4/8/21 at 0128am: BP 110/58 | Pulse 120 | Temp 97 ?F F (36.1 ?C) C) | Resp (!) 34 | Ht 5'' 2.99" (1.6 m) | Wt 125 lb 10.6 oz (57 kg) | SpO2 97% | BMI 22.27 kg/m? kg/m Normal PE in ED: Constitutional: She is oriented to person, place, and time. She appears well , well-developed, well-nourished and appears stated age. Non-toxc appearing, no nystagmus or gaze deviation, no meningismus or rigidity, 2+ equal pulses in all extremities, tachycardic, regular. Code sepsis called at 0250. At 0951 - Dr.at bedside will take patient to the OR for possibly VA ECMO for ischemic cardiomyoptahy. Medications: ASA, brilinta and heparin drip. Started on cefepime, vancomycin and azithromycin (D1) for suspected multifocal pneumonia Patient became hypotensive in the course of the morning and was transferred to the cath lab for urgent cardiac catheterization that showed non-obstructive CAD, elevated filling pressures, normal CO (on levophed). Echo showed LVEF 29%, biventricular failure, global hypokinesis. No valve disease 4/8/21 at 1012 - Cardiothoracic Surgery: Physical Exam positive for: Constitutional: She appears well-developed and well-nourished. She appears toxic. She has a sickly appearance. She appears ill. She appears distressed. Nasal cannula in place. Neck: Normal range of motion. Neck supple. JVD present. Cardiovascular: Regular rhythm. Tachycardia present. Murmur heard. Systolic murmur is present with a grade of 2/6. Pulmonary/Chest: Effort normal. No respiratory distress. She has rales. Abdominal: Soft. She exhibits no distension. There is abdominal tenderness. There is no rebound and no guarding. Neurological: She is alert. She has normal strength. A sensory deficit is present. Skin: Skin is dry and intact. Ecchymosis noted. She is not diaphoretic. There is cyanosis. There is pallor. Psychiatric: Judgment and thought content normal. Her mood appears anxious. Her speech is delayed. She is agitated. Cognition and memory are normal. Assessment: 1) Cardiogenic shock -discussed extensively with patient and husband high likelihood for need for V-A ECMO support 2) NSTEMI -f/u LHC to eval for CAD 3) Essential thrombocytosis - rec heme consult as plts significantly elevated and high risk of thrombus/embolism development 4) Pericardial effusion - rpt echo in AM but no indication for intervention at this time as no evidence of tamponade physiology by echo 4/8/21 at 1230 - Cardiothoracic surgery note: Patient evaluated at bedside with cardiology at time of cardiac cath with decision for no ECMO support as per cardiology recs secondary to shock not thought to be cardiogenic primary in nature with further management as per MICU. 4/8/21 at 1254 - Coronary Care Unit note: CTA abdomen and pelvis showed no acute aortic disease, no ischemic bowel, small linear filling defect in proximal celiac trunk may represent nonocclusive thrombus, stable small mildly hyperdense pericardial effusion. She was taken to the OR for cath and possible ECMO. Found to be agitated and confused. She was intubated in the OR and pressors were started (Levophed and epinephrine). IABP placed during cath, but removed due to good cardiac function. No coronary artery disease on cath. RIJ Swan Ganz placed. During the course of hours WBC increased to 30 and then to 45. Her pressors requirements increased and the acid base status woresened, with depleted bicarb and low pH. Currently on broad spectrum ATB (cefepime, Vancomycin and azithromycin) with infusion of flis and albumin, bicarb pushes (2) and gtt, on Levophed and vasopressin. Currently on broad spectrum ATB (cefepime, Vancomycin and azithromycin) with infusion of IVF and albumin, bicarb pushes (2) and gtt, on Levophed and vasopressin. 4/8/21 at 2127 - Surgery note: We are consulted due to concern for bowel ischemia. The patient is on max dose of Levo, Vaso, Epi with refractory hypotension and acidosis. Her CT shows all mesenteric vessels are patent and no bowel thickening, stranding, or free fluid to suggest bowel ischemia. The abdomen is soft non tender and non distended. In the setting of multiorgan failure and low flow state, non occlusive mesenteric ischemia would be expected but would be diffuse in nature rather than focal. There is no role for surgical resection for diffuse bowel ischemia if it develops--the mainstay of treatment being to improve her overall perfusion to vital organs. She may benefit from ionotropic support in addition to vasopressors. Code Blue called 4/9/2021 at 0045 ? patient found unresponsive, asystole. History: 62 y.o female history of ET, melanoma s/p surgical removal and immunotherapy, presented with septic shock with metabolic acidosis, intubated, sedated on pressors, levophed, epinephrine and vasopressin drip. Pertinent Lab Prior to or at Onset of Code: pH 7.12/31/133/10.1/95%


Changed on 5/14/2021

VAERS ID: 1186600 Before After
VAERS Form:2
Age:62.0
Sex:Female
Location:Foreign
Vaccinated:2021-04-04
Onset:2021-04-05
Submitted:0000-00-00
Entered:2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 AR / SYR

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain, Abdominal tenderness, Acidosis, Acute myocardial infarction, Agitation, Angiogram pulmonary normal, Anxiety, Arteriogram coronary abnormal, Aspartate aminotransferase increased, Asthenia, Blood bicarbonate decreased, Blood calcium decreased, Blood creatine phosphokinase increased, Blood lactic acid, Blood pH decreased, Blood sodium decreased, Blood urea increased, Cachexia, Carbon dioxide decreased, Cardiac arrest, Cardiac failure congestive, Cardiac murmur, Cardio-respiratory arrest, Cardiogenic shock, Catheterisation cardiac abnormal, Confusional state, Coronary artery disease, Cyanosis, Dry skin, Dyspnoea, Ecchymosis, Echocardiogram, Electrocardiogram abnormal, Essential thrombocythaemia, Fatigue, Haematocrit increased, Haemoglobin increased, Hypokinesia, Hypotension, Intensive care, International normalised ratio normal, Lymphocyte count increased, Malaise, Nausea, Pain, Pallor, Pericardial effusion, Pneumonia, Sepsis, Septic shock, Sinus tachycardia, Speech disorder developmental, Tachycardia, Unresponsive to stimuli, Vomiting, White blood cell count increased, Emotional distress, Platelet count increased, Thoracic operation, Intra-aortic balloon placement, Computerised tomogram abdomen, Pulmonary mass, Troponin increased, General physical condition abnormal, Jugular vein distension, Liver function test normal, Decreased appetite, Echocardiogram abnormal, Endotracheal intubation, Body temperature normal, Multiple organ dysfunction syndrome, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-09
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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown. Recent travel history
Preexisting Conditions: HPI: hx of melanoma s/p immunotherapy 2 years ago, chronic thrombocytosis with 7-8 year history on agrelid, followed by Dr.
Allergies: No known allergies allergies
Diagnostic Lab Data: 4/8/21: CTA in all lung fields, no hypoxia or tachypnea on room air. Non tender in all quadrants, no peritoneal signs. No pedal edema or tenderness bilaterally. CTA was negative for PE, revealed multiple pulmonary nodules largest measuring 1 cm in the left upper lobe and additional nodules 0.9 cm in the lateral right middle lobe and 0.9 cm in the inferior lingula. 0.9 nodule in the inferior linear surrounding tree in bud opacity suggestive of atypical infectious process. EKG 4/8/21 at 0113 Rate: 121, Rhythm: sinus tachycardia, no ST elevation. QTC 462, QRS 72. Repeat EKG read at 0341 Rate: 124, Rhythm: sinus tachycardia, no ST elevation, unchagned from prior. Labs at 0120 - Hgb (18.5), Hct (56.9), Plt (940), Immgrans (1.7), Lympohcytes (4.4); Na (132), CO2 (20), BUN (32.0), Createnine GFR (1.12), EGFR (49), Calcium (8.6). LFTs normal except AST (59). INR 1.1, CPK (1,109), Troponin (4.7) Blood work with elevated troponin (4.7 at 0120, 6.272 at 0755), no STEMI criteria, never with CP or SOB evaluated by cardiology , started on DAPT and heparin , CTPA obtained due to high risk factors for PE with melanoma in the past, recent travel and possible adverse reaction/cogulopathy with vaccine, no PE possible infectious/malignant features in lungs. Blood work also with elevated WBC (22.88 at 0532) and lactic acid (7.8 at 0604; 8.5 at 0755), negative beta hydroxy but with a very low ph, tox screen positive for opiates / tylenol/aspirin levels unremarkable. CPK 1,781 at 0830. SARS coronavirus-2 RNA (COVID-19) test negative at 0212. Labs at 0830 - WBC (30.30), Hgb (17.5), Hct (54.4), Plt (884), Na (136), CO2 (14.3), BUN (33.4), Createnine GFR (1.05), Calcium (7.7), CPK (1,781), Troponin (3.973, 4.031) Echo at 0846 - depress EF between 30-40%, with pericardial fluids, possible pericardial tamponade. At 0900 - ordered CTA chest/abd/pelvis for aortic dissection, the risk of CIN was considered but the benefit outweigh the complication. 4/8/21 at 1040 - Perioperative anesthesia eval: 1) Emergent insertion of peripheral percutaneous venous and arterial ECMO cannulae 2) Emergent initiation of veno-arterial extracorporeal membrane oxygenation support 3) Emergent insertion of distal perfusion cannula 4) Ultrasound guided vascular access 5) Lower extremity angiograms 6) Transthoracic and/or transesophageal echocardiogram(s) 7) Left heart catheterization with coronary angiography LHC showed Non obstructive CAD, LVEDP 37 mmHg (Elevated left sided filling pressures) and RHC showed PA pressure 36/30 mmHg, mean 33mmHg; Sat mixed venous 79%, Ao 98%; CO Fick 5.1, CI 3.26. Pertinent Lab Prior to or at Onset of Code: pH 7.12/31/133/10.1/95%
CDC 'Split Type':

Write-up: ED note: 62 year old patient presented to Main ED on 4/8/21 at 0120. Patient arrived by ambulance and her chief complaint was left sided abdominal pain associated with generalized weakness, malaise, and fatigue x 3 days. HPI: hx of melanoma s/p immunotherapy 2 years ago, chronic thrombocytosis with 7-8 year history on agrelid, followed by Dr. Patient travelled recently. She received her Johnson and Johnson Covid vaccine Sunday afternoon (4/4). The next day she started to feel unwell with malaise, generalized weakness and body aches. with subjective fevers on Monday (4/5), nausea and 1 episode of non bilious vomiting. She refers severe pain that did not improved with ibuprofen, as well as increased fatigue, anorexia and has been unable to drink or eat any food for the past couple of days. As per her husband she also developed SOB with exertion yesterday. No fever, chills, constipation, diarrhea, blurred vision, numbness or paresthesias. Travel 4 days prior and receiving johnson and johnson covid vaccine. No modifying factors. No urinary sx, cough, no sick contacts. Pt denies measured fevers, chills, diarrhea, chest pain, SOB, blood in stool, headache, vision changes, numbness/tingling, focal weakness. No prior hx of MI / PE, no history of similar pain , no abdominal surgeries. PMHx: melanoma, thrombocytosis ; PSHx: none ; Social Hx: (-) tobacco, (-) EtOH, (-) illicit drug use ; Allergies: none ; PCP: in another country NKDA. Family history: Mother CKD. Social history: she is married, originally from another country; has been living in another location for the last 3 months. She is an architect Denies any sick contacts. Her husband has been vaccinated for COVID-19.Travel screening done in the ED: no/unsure if in the last month she may have been in contact with someone who was confirmed or suspected to have COVID-19. Yes (negative result) to "have you had a COVID-19 viral test in the last 14 days. No to "do you have any of the following new or worsening symptoms?" and no to have you traveled internationally in the last month? No documented travel since 03/08/21. No to all high risk personnel screen questions. Physical Exam on 4/8/21 at 0128am: BP 110/58 | Pulse 120 | Temp 97 F ?F (36.1 C) ?C) | Resp (!) 34 | Ht 5'' 2.99" (1.6 m) | Wt 125 lb 10.6 oz (57 kg) | SpO2 97% | BMI 22.27 kg/m kg/m? Normal PE in ED: Constitutional: She is oriented to person, place, and time. She appears well , well-developed, well-nourished and appears stated age. Non-toxc appearing, no nystagmus or gaze deviation, no meningismus or rigidity, 2+ equal pulses in all extremities, tachycardic, regular. Code sepsis called at 0250. At 0951 - Dr.at bedside will take patient to the OR for possibly VA ECMO for ischemic cardiomyoptahy. Medications: ASA, brilinta and heparin drip. Started on cefepime, vancomycin and azithromycin (D1) for suspected multifocal pneumonia Patient became hypotensive in the course of the morning and was transferred to the cath lab for urgent cardiac catheterization that showed non-obstructive CAD, elevated filling pressures, normal CO (on levophed). Echo showed LVEF 29%, biventricular failure, global hypokinesis. No valve disease 4/8/21 at 1012 - Cardiothoracic Surgery: Physical Exam positive for: Constitutional: She appears well-developed and well-nourished. She appears toxic. She has a sickly appearance. She appears ill. She appears distressed. Nasal cannula in place. Neck: Normal range of motion. Neck supple. JVD present. Cardiovascular: Regular rhythm. Tachycardia present. Murmur heard. Systolic murmur is present with a grade of 2/6. Pulmonary/Chest: Effort normal. No respiratory distress. She has rales. Abdominal: Soft. She exhibits no distension. There is abdominal tenderness. There is no rebound and no guarding. Neurological: She is alert. She has normal strength. A sensory deficit is present. Skin: Skin is dry and intact. Ecchymosis noted. She is not diaphoretic. There is cyanosis. There is pallor. Psychiatric: Judgment and thought content normal. Her mood appears anxious. Her speech is delayed. She is agitated. Cognition and memory are normal. Assessment: 1) Cardiogenic shock -discussed extensively with patient and husband high likelihood for need for V-A ECMO support 2) NSTEMI -f/u LHC to eval for CAD 3) Essential thrombocytosis - rec heme consult as plts significantly elevated and high risk of thrombus/embolism development 4) Pericardial effusion - rpt echo in AM but no indication for intervention at this time as no evidence of tamponade physiology by echo 4/8/21 at 1230 - Cardiothoracic surgery note: Patient evaluated at bedside with cardiology at time of cardiac cath with decision for no ECMO support as per cardiology recs secondary to shock not thought to be cardiogenic primary in nature with further management as per MICU. 4/8/21 at 1254 - Coronary Care Unit note: CTA abdomen and pelvis showed no acute aortic disease, no ischemic bowel, small linear filling defect in proximal celiac trunk may represent nonocclusive thrombus, stable small mildly hyperdense pericardial effusion. She was taken to the OR for cath and possible ECMO. Found to be agitated and confused. She was intubated in the OR and pressors were started (Levophed and epinephrine). IABP placed during cath, but removed due to good cardiac function. No coronary artery disease on cath. RIJ Swan Ganz placed. During the course of hours WBC increased to 30 and then to 45. Her pressors requirements increased and the acid base status woresened, with depleted bicarb and low pH. Currently on broad spectrum ATB (cefepime, Vancomycin and azithromycin) with infusion of flis and albumin, bicarb pushes (2) and gtt, on Levophed and vasopressin. Currently on broad spectrum ATB (cefepime, Vancomycin and azithromycin) with infusion of IVF and albumin, bicarb pushes (2) and gtt, on Levophed and vasopressin. 4/8/21 at 2127 - Surgery note: We are consulted due to concern for bowel ischemia. The patient is on max dose of Levo, Vaso, Epi with refractory hypotension and acidosis. Her CT shows all mesenteric vessels are patent and no bowel thickening, stranding, or free fluid to suggest bowel ischemia. The abdomen is soft non tender and non distended. In the setting of multiorgan failure and low flow state, non occlusive mesenteric ischemia would be expected but would be diffuse in nature rather than focal. There is no role for surgical resection for diffuse bowel ischemia if it develops--the mainstay of treatment being to improve her overall perfusion to vital organs. She may benefit from ionotropic support in addition to vasopressors. Code Blue called 4/9/2021 at 0045 ? patient found unresponsive, asystole. History: 62 y.o female history of ET, melanoma s/p surgical removal and immunotherapy, presented with septic shock with metabolic acidosis, intubated, sedated on pressors, levophed, epinephrine and vasopressin drip. Pertinent Lab Prior to or at Onset of Code: pH 7.12/31/133/10.1/95%

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