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

This is VAERS ID 1689261

Case Details

VAERS ID: 1689261 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: California  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain, Acute kidney injury, Arterial occlusive disease, Computerised tomogram abdomen abnormal, Death, Duodenitis, Gastritis bacterial, Hepatic enzyme increased, Intensive care, Intestinal perforation, Mental status changes, Nausea, Pancreatitis, Pneumoperitoneum, Respiratory failure, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Gastrointestinal perforation (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific inflammation (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Tumour lysis syndrome (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-08-24
   Days after onset: 3
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Estrogen for male to female transition.
Current Illness: none
Preexisting Conditions: None. Patient was male to female transition and was taking hormone therapy to assist in transition.
Allergies: none
Diagnostic Lab Data: patient had a CT scan of the abdomen and pelvis showing emphysematous gastritis and duodenitis. She also had pancreatitis. Patient had marked elevation in liver enzymes that continued to worsen throughout her hospital stay. She had no previous liver problems. She also had acute kidney failure. There is suspicion that the patient developed an arterial occlusion in the abdominal vasculature that could have precipitated this event. Unfortunately this is not proven and only clinical suspicion. An autopsy was not done.
CDC Split Type:

Write-up: Patient had her 1st dose of the vaccine on Friday 8/20. Over the next day the patient developed nausea, vomiting and abdominal pain. The pain continued until the patient presented to the emergency department on 08/22. Patient was found to have emphysematous gastritis. She was started on antibiotics and admitted to the intensive care unit. The patient also had significant elevation in liver enzymes. She developed altered mental status and eventually respiratory failure and was unable to protect her airway. Further radiologic examinations showed perforated viscus and diffuse pneumoperitoneum. Patient died on 08/24.

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