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

This is VAERS ID 1218602

Case Details

VAERS ID: 1218602 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Maine  
   Days after vaccination:42
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Abdominal X-ray, COVID-19, Cerebral atrophy, Chest X-ray abnormal, Computerised tomogram abdomen abnormal, Computerised tomogram head abnormal, Computerised tomogram pelvis abnormal, Encephalomalacia, Endotracheal intubation, Gastrointestinal necrosis, Hypotension, Lung infiltration, Magnetic resonance imaging, Mechanical ventilation, Mental status changes, Metabolic acidosis, Platelet count normal, Pneumatosis intestinalis, Pneumobilia, Portal venous gas, Pyrexia, Renal failure, SARS-CoV-2 test positive, Shock
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (broad), Anaphylactic reaction (narrow), Angioedema (broad), Lactic acidosis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (narrow), Toxic-septic shock conditions (narrow), Anaphylactic/anaphylactoid shock conditions (narrow), Hypoglycaemic and neurogenic shock conditions (narrow), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Ischaemic colitis (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypotonic-hyporesponsive episode (broad), Chronic kidney disease (narrow), Hypersensitivity (narrow), Tumour lysis syndrome (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-04-13
   Days after onset: 1
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen(acetaminophen 325 mg oral tablet), 650 mg= 2 TAB, PO, Every 4 Hours, PRN atorvastatin(atorvastatin 20 mg oral tablet), 40 mg= 2 TAB, PO, Daily azelastine nasal(azelastine 137 mcg/inh (0.1%) nasal spray), 2 Sprays, NASAL, Twi
Current Illness: COVID+
Preexisting Conditions: Acute kidney injury Bipolar affective Chronic pain Depression Elevated LFTs Encephalopathy Hematuria History of DVT in adulthood Mitral valve stenosis Panic attack Sepsis Stroke Urinary anomaly
Allergies: NSAIDs
Diagnostic Lab Data: see above
CDC Split Type:

Write-up: colonic necrosis 62 yo woman history of prior L occipital CVA and DVT on Xarelto presented to Hospital on April 6 with mental status changes. Patient was noted to be in severe metabolic acidosis, renal failure and shock. Chest x-ray showed interstitial infiltrates and she tested positive for SARS-CoV2. She required intubation and mechanical ventilation. CT brain showed encephalomalacia and atrophy, no new changes. She was transferred on April 8. She was given IV bicarb for persistent metabolic acidosis. Initially she was only treated with steroids, then antibiotics were added for fever and persistent hypotension. She started to spike fevers up to 40. Abdominal CXR ordered prior to MRI, showed possible pneumatosis. A follow up CT April 13 abdomen/pelvis was done which shows colonic pneumatosis, with air in the SMV, portal vein, air in the liver. No thrombocytopenia; platelets on April 13 were 310k, as low as 260 on April 8.

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