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This is VAERS ID 1362539

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1362539
VAERS Form:2
Age:44.0
Sex:Male
Location:New Jersey
Vaccinated:2021-05-13
Onset:2021-05-28
Submitted:0000-00-00
Entered:2021-05-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain, Blood fibrinogen decreased, Dyspnoea, Fibrin D dimer increased, Haemoglobin decreased, Lung infiltration, Lymphadenopathy mediastinal, Melaena, Platelet count decreased, Thrombocytopenia, Contusion, Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Retroperitoneal lymphadenopathy

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-05-31
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: May 28 - Platelet 100, Hgb 10.5 CT of Chest : no PE, bilateral infiltrates and mediastinal lymphadenopathy Fibrinogen 34 D Dimer greater than 5000 CT of abdomen : retroperitoneal LN
CDC 'Split Type':

Write-up: Pt presented to the hospital with abdominal pain and shortness of breath May 28, 2021 Noted to be thrombocytopenic - had normal platelet 20 days prior Had bruising, melena

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