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This is VAERS ID 1362511

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1362511
VAERS Form:2
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other      Purchased by: ??
Symptoms: Angiogram pulmonary abnormal, Back pain, Blood calcium decreased, Blood chloride decreased, Blood glucose increased, Blood sodium decreased, Chest X-ray abnormal, Chills, Condition aggravated, Cough, Death, Diarrhoea, Differential white blood cell count abnormal, Dyspnoea, Eye pain, Fatigue, Feeling abnormal, Fibrin D dimer increased, Full blood count abnormal, Haematocrit increased, Haemoglobin increased, Headache, Hyperaesthesia, Lung disorder, Lymphadenopathy, Lymphadenopathy mediastinal, Monocyte count increased, Pain, Pain of skin, Platelet count decreased, Pleural effusion, Pyrexia, Rash, Red blood cell count increased, Sepsis, Shock, Vomiting, Protein urine present, Brain natriuretic peptide normal, Laboratory test normal, Metabolic function test abnormal, Urine analysis abnormal, Procalcitonin, Oropharyngeal pain, Legionella test, Streptococcus test negative, Influenza virus test negative, Troponin I normal, Lung opacity, SARS-CoV-2 test negative

Life Threatening? Yes
Birth Defect? No
Died? Yes
   Date died:2021-03-02
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zyrtec 10mg, CBD Oil Thoughtcloud Sublingual
Current Illness: Possible illness 2 days prior to vaccine - achey from golf/pil. Thought achey from golf and pilates possibly. Stress. High Cholesterol.
Preexisting Conditions: High Cholesterol
Allergies: seasonal and pollens/trees/grasses
Diagnostic Lab Data: 2/26/21 UrgentCare: Flu test - neg, Covid-19 test - neg, Chest xray - normal ? 2/28/21 UrgentCare: Urine test - neg, BMP=abnormal: 105H glucose, 134L sodium, 8.3L calcium CBC=ab. CBC=abnormal: 122L platelet count 3/1/2021 HOSPITAL Chest Xray - diffuse patch opacities, moderate central and lower lung predominant opacity which could reflect pneumonia, acute edema might have this appearance however there is no cardiac enlargement or pleural effusion to etiology; CTA chest - Mildly limited at detailed in xray, no pulmonary embolism found, moderate diffuse interlobular septal thickening and patch lung opacity, this could reflect alveolar and interstitial edema or pneumonia, small bilateral pleural effusions, mild mediastinal adenopathy, possible hilar adenopathy, and mild left axillary adenopathy; CBCwDif=abnormal RBC 6.16H, Hemoglobin 18.5H, Hematocrit 54.9H, Platelets 73L, Monocytes Absolute .96, BMP=abnormal Sodium 129L, Choride 95L, Calcium 8.3L, Glucose 150H; UAwMicro=abnormal 100 protein; D-Dimer Quant=abnormal 1.52; Troponin I=normal, B-type natriuretic peptide=normal, POC Covid-19 test=negative, Molecular, ABBOTT ID Now; Procalcitonin ?; Leionella=neg; Pneumococcal antigen=neg; Strep Pneomo antigen urine=neg
CDC 'Split Type':

Write-up: Skin hurting/sensitivity (Day 1 forward), severe chills (day 2 forward), headache (day 1 forward), fatigue (day 1 forward), mild cough on/off, eye pain (? day 4 forward), achey (day 1 forward), chest rash (? day 3 forward), fever (? day 5 forward 101.9 day 5), back pain (? day 5 forward), labored breathing (? day 5 forward), diarrhea (? day 5 forward), sore throat (? day 5 forward) vomit (day 7). Symptoms of chills and miserable feeling increased day 4 on. Tylenol, Albuterol on day 6, Day 8 hospitalized, antibiotics and oxygen, Sepsis and shock, less than one day in hospital - passed on 3/2/21 am.

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