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From the 10/8/2021 release of VAERS data:

This is VAERS ID 1545487

Case Details

VAERS ID: 1545487 (history)  
Form: Version 2.0  
Age: 72.0  
Sex: Male  
Location: Florida  
   Days after vaccination:172
Submitted: 0000-00-00
Entered: 2021-08-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Unknown       Purchased by: ?
Symptoms: Bilevel positive airway pressure, Blood gases, COVID-19, Chest X-ray, Chest pain, Condition aggravated, Cough, Death, Dyspnoea, Emphysema, Endotracheal intubation, Epistaxis, Fatigue, Hyperglycaemia, Hypogeusia, Hypoxia, Infection, Insomnia, Laboratory test, Mechanical ventilation, Muscle spasms, Nasal dryness, Oxygen saturation decreased, Pyrexia, Refusal of treatment by patient, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haemorrhage terms (excl laboratory terms) (narrow), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-09
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amitriptyline (ELAVIL) 10 MG Oral Tablet Take 3 tablets by mouth nightly at bedtime. 9/23/20 amLODIPine (NORVASC) 10 MG Oral Tablet TAKE 1 TABLET BY MOUTH EVERY DAY 9/24/20 aspirin 81 MG Tablet Delayed Release Take by mouth daily.
Current Illness:
Preexisting Conditions: No date: Actinic keratosis No date: Angiopathy No date: Basal cell carcinoma No date: Cancer (CMS-HCC: 12) No date: Chronic renal disease, stage III No date: Coronary heart disease No date: Dermatitis No date: Diabetes mellitus Comment: Type 2 No date: Elevated transaminase level No date: Fatty liver No date: GERD (gastroesophageal reflux disease) No date: Hyperlipidemia No date: Hypertension No date: Insomnia No date: OSA on CPAP No date: Peripheral polyneuropathy No date: Psoriasis No date: Restless leg No date: Sleep apnea No date: Squamous cell carcinoma of skin No date: Thyroid disease Comment: Hypothyroidism No date: Vitamin D deficiency
Allergies: ? Kenalog [Triamcinolone] - Rash Only ointment he has severe reaction too. ? Latex - Rash
Diagnostic Lab Data: (COVID-19), NAA FLU-RSV-SARS NAAT Collected: 07/26/21 1151 - confirmed positive CORONAVIRUS (COVID-19), NAA Collected: 07/27/21 2235 - confirmed positive
CDC Split Type:

Write-up: Patient was hospitalized due to breakthrough covid-19 infection on 7/27/21 with complaints of shortness of breath, nonproductive cough, daily fevers, decrease taste, chest pain when coughing, and fatigued. Patient completed the Pfizer vaccine series in February. Patients condition worsened over hospital course and he was pronounced deceased on 8/09/21 @21:55. Below information is copied from progress note on 8/08/21: 7/30/21: Patient has had no new issues overnight. He remains on HFNC + NRB 80L/100% maximum support, refusing bipap. Educated on importance of utilizing bipap, still refusing. Sats remain mid 80s. 8/1: No acute events overnight. Tol slow wean of HFNC. Bipap overnight. Hemodynamically stable. 8/2: No acute events overnight. On FFB overnight 85% 12/8. Was reportedly in chair most of the day yesterday on HFNC 70%/70l with stable sats. Hemodynamically stable. No fevers. 8/3:Patient sitting up in chair , on HFNC, nostrils bloody and with dry mucus. Requesting to be placed on regular diet with no restrictions. Uneventful night. 8/4: Sats upon intial exam this AM by this provider were 77%. Pt had just transferred bed to chair with HFNC and NRB. Sats slow to recover but with NRB, slowly improved to 89%. Pt states that he slept poorly last night and this AM upon getting up had trouble with severe left thigh cramp. Was given Robaxin, pain med, warm pack to thigh and is better now. Added Melatonin to HS meds prn to help with sleep. Additional aspart given for hyperglycemia. 8/5: no events overnight. Patient remained on BIPAP with no issues. 8/6: Pt required BIPAP d/t decreasing O2 sats to low 80s on HFNC. 8/7: Intubated last night for hypoxemia refractory to FFB 100%. Currently stable sats on APRN 100%, PH 30. Sub cut emphysema to neck. AM CXR, ABG, and labs pending. TF ordered. Wife notified of intubation- she was diagnosed with covid at same time as husband. She will contact her son who has been fully immunized and no current covid s/s. 8/8: patient remained intubated and sedated on ventilator overnight. APRV PH 24, 95% fiO2

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