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This is VAERS ID 1310558

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1310558
VAERS Form:2
Age:56.0
Sex:Female
Location:California
Vaccinated:2021-04-30
Onset:2021-05-02
Submitted:0000-00-00
Entered:2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA UNKNOWN / 2 UN / UN

Administered by: Unknown      Purchased by: ??
Symptoms: Abdominal pain upper, Anaemia, Chills, Confusional state, Depressed level of consciousness, Faeces discoloured, Gastrointestinal haemorrhage, Haematemesis, Melaena, Nausea, Pain, Pyrexia, Restlessness, Upper gastrointestinal haemorrhage, Vomiting, Mental status changes, Metabolic encephalopathy, Discoloured vomit

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: presented with altered mental status and hematemesis and admitted for metabolic encephalopathy and severe anemia secondary to upper GI bleeding. Patient was in her usual state until 3 days prior to admission when she had her 2nd dose of COVID-19 vaccination that she started to experience generalized body aches accompanied by fever and chills a day later. She also developed epigastric pain accompanied by nausea and vomiting which was later noted to have dark colored vomitus. One day prior to admission, she went to Urgent Care and was given Famotidine. Yesterday, she was found to be obtunded with dark colored vomitus and black tarry stools and was sent to ER where she was noted to have severe anemia. GI consult called for further evaluation. Patient still confused and restless. History taken from chart and from nursing staff. Currently, no more hematemesis and no BM.

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