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

This is VAERS ID 1228761



Case Details

VAERS ID: 1228761 (history)  
Form: Version 2.0  
Age: 91.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-18
Onset:2021-03-25
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EP6955 / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Angiogram pulmonary abnormal, Atypical mycobacterial lower respiratory tract infection, Blood potassium decreased, Blood potassium increased, Brain natriuretic peptide increased, Carbon dioxide increased, Full blood count, Lung consolidation, Metabolic function test, Mycobacterium avium complex infection, Respiratory depression, SARS-CoV-2 test negative, Troponin increased, White blood cell count increased
SMQs:, Cardiac failure (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (narrow), Opportunistic infections (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-29
   Days after onset: 4
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Benzonatate malodipine Omeprazole Furosemide Montelukast Fluticasone Levothyroxine Nystatin Metoprolol Apixaban Gabapentin Meclizine Humulin R Simethicone Timolol Ipratropium-albuterol
Current Illness: None but chronic conditions
Preexisting Conditions: CHF A flutter with pacemaker HTN DM II PVD Hyperlidemia Asthma
Allergies: Codeine Pravastatin Enalapril
Diagnostic Lab Data: 3/27BMP - elevated K 5.8 0345 an d3. at 1221 Co2 37 and 36 respectively 3/25-3/26 CBC - elevated wbc 20.61 & 28.94 respectively 3/25 COVID ID now - negative
CDC Split Type:

Write-up: Note from 3/25/2021: PMH of asthma, PVD, Diabetes Mellitus type 2, Diastolic CHF , Aflutter , hypothyroidism , and allergies, who presents to facility with after her home provider saw her and concerned for pneumonia and worsening respiratory status. Lab work-up showed elevated WBC of 20.61, low potassium 3.2 , and BNP of 764. Her troponin was also elevated 0.147. Chest CTA done showed atypical infectious process with consolidation at the left lung base and secondary to pulmonary mycobacterium avium complex infection in the bronchiectatic form .Patient is a 91 year old female with PMH of asthma, PVD, Diabetes Mellitus type 2, Diastolic CHF , Aflutter , hypothyroidism , and allergies, who presents to facility with after her home provider saw her and concerned for pneumonia and worsening respiratory status. Lab work-up showed elevated WBC of 20.61, low potassium 3.2 , and BNP of 764. Her troponin was also elevated 0.147. Chest CTA done showed atypical infectious process with consolidation at the left lung base and secondary to pulmonary mycobacterium avium complex infection in the bronchiectatic form .


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