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

This is VAERS ID 1218764



Case Details

VAERS ID: 1218764 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-02-10
Onset:2021-04-06
   Days after vaccination:55
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9089 / UNK - / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9089 / UNK - / IM

Administered by: Other       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Brain herniation, Cerebral haemorrhage, Cerebral mass effect, Chest X-ray abnormal, Computerised tomogram head abnormal, Condition aggravated, Deep vein thrombosis, Haemoglobin decreased, International normalised ratio increased, Leukaemia recurrent, Leukapheresis, Leukocytosis, Lung infiltration, Lung opacity, Oedema peripheral, Platelet count decreased, Prothrombin time prolonged, Respiratory viral panel, Subdural haemorrhage, Thrombocytopenia, Viral test negative, White blood cell count increased
SMQs:, Cardiac failure (broad), Liver-related coagulation and bleeding disturbances (narrow), Angioedema (broad), Haematopoietic erythropenia (broad), Haematopoietic thrombocytopenia (narrow), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Accidents and injuries (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Haematological malignant tumours (narrow), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died: 2021-04-08
   Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Carvedilol (Coreg), acyclovir, Lipitor, HCTZ, lisinopril, metformin, Ivosidenib (Tibsovo), Allopurinol (Zyloprim), Acetaminophen (Tylenol)
Current Illness: AML, CKD, T2DM, HTN, HLD
Preexisting Conditions: AML
Allergies: Sulfa drug, citrus, latex
Diagnostic Lab Data: INR 1.8. PT 20.1, PTT 24.7, WBC 102K, Hgb 6.7, platelet 57, respiratory viral panel negative. CXR: Patchy ground-glass opacities in the right upper lobe and right lower lobe. Mild interstitial infiltrates in the upper lobes bilaterally. Extensive DVT from the right common femoral vein through the distal popliteal vein. CT brain: Left occipital intraparenchymal hemorrhage measuring 5.8 x 2.8 x 3.1 cm as well as diffuse left hemispheric subdural hemorrhage measuring 11 mm, resulting in 16 mm rightward midline shift, subfalcine, and left uncal herniation.
CDC Split Type:

Write-up: Patient with Hx of AML received 1st dose COVID vaccine 2/10/2021, 2nd dose 3/4/2021. She developed DVT of the right leg, AML relapse. The patient has been diagnosed with AML back in 2016 and underwent several lines of therapy including chemotherapy with 7 and 3 and the last treatment was decitabine with maintenance treatment with ivosidenib. Having severe leukocytosis and right-sided leg edema with DVT raised concern about blast crisis and leukostasis. Patient was admitted to hospital and received. ceftriaxone and azithromycin for possible pneumonia. She underwent leukophoresis on the 4/6/2021, 4/7/2021. Patient received IV heparin gtt for DVT but later on was on hold given worsening thrombocytopenia. She was transferred from one hospital to another hospital. I do not think the development of DVT was due to COVID vaccine. But prior to COVID vaccine, patient was in AML remission.


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