National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/26/2021 release of VAERS data:

This is VAERS ID 1693455

Government Disclaimer on use of this data



Case Details

VAERS ID: 1693455 (history)  
Form: Version 2.0  
Age: 85.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-08
Onset:2021-09-10
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 939901 / 3 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Anxiety, Atrial fibrillation, Blood glucose normal, Brain natriuretic peptide, Chest X-ray, Electrocardiogram repolarisation abnormality, Fatigue, Ischaemia, Left ventricular dysfunction, Left ventricular failure, Lethargy, Malaise, Nausea, Pain of skin, Rales, SARS-CoV-2 test, Wheezing
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Arrhythmia related investigations, signs and symptoms (narrow), Conduction defects (narrow), Supraventricular tachyarrhythmias (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Hypoglycaemia (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: PARoxetine HCl Tablet 20 MG Give 1 tablet by mouth one time a day for GAD Pharmacy Active 9/4/2021 07:00 9/3/2021 Warning: Controlled Drug There is a black box warning associated with this order. Please click to view details. The Resident
Current Illness: UNSPECIFIED ATRIAL FIBRILLATION (I48.91) 5/4/21 Primary/Principal/Admission (67) Primary/Principal/Admission SHORTNESS OF BREATH (R06.02) 5/4/21 Secondary #1 Admitting Dx (69) CHRONIC COMBINED SYSTOLIC (CONGESTIVE) AND DIASTOLIC (CONGESTIVE) HEART FAILURE (I50.42) 5/4/21 Secondary #2 Admitting Dx (69) MUSCLE WEAKNESS (GENERALIZED) (M62.81) 5/5/21 Secondary #3 Admitting Dx (69) UNSTEADINESS ON FEET (R26.81) 5/5/21 Secondary #4 Admitting Dx (69) NEED FOR ASSISTANCE WITH PERSONAL CARE (Z74.1) 5/5/21 Secondary #5 Admitting Dx (69) HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE WITH HEART FAILURE AND STAGE 1 THROUGH STAGE 4 CHRONIC KIDNEY DISEASE, OR UNSPECIFIED CHRONIC KIDNEY DISEASE (I13.0) 5/4/21 Secondary #6 Admitting Dx (69) TYPE 2 DIABETES MELLITUS WITH HYPERGLYCEMIA (E11.65) 5/4/21 Secondary #7 Admitting Dx (69) DYSPHAGIA, UNSPECIFIED (R13.10) 8/1/21 Secondary 9 Or More During Stay KLEBSIELLA PNEUMONIAE [K. PNEUMONIAE] AS THE CAUSE OF DISEASES CLASSIFIED ELSEWHERE (B96.1) 7/19/21 Secondary 9 Or More During Stay URINARY TRACT INFECTION, SITE NOT SPECIFIED (N39.0) 7/19/21 Secondary 9 Or More During Stay OTHER SYMBOLIC DYSFUNCTIONS (R48.8) 7/16/21 Secondary 9 Or More During Stay ALLERGY STATUS TO UNSPECIFIED DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES (Z88.9) 6/1/21 Secondary 9 Or More CONSTIPATION, UNSPECIFIED (K59.00) 5/5/21 Secondary 9 Or More Admitting Dx (69) HYPOTHYROIDISM, UNSPECIFIED (E03.9) 5/5/21 Secondary 9 Or More Admitting Dx (69) INSOMNIA, UNSPECIFIED (G47.00) 5/5/21 Secondary 9 Or More Admitting Dx (69) MAJOR DEPRESSIVE DISORDER, RECURRENT, UNSPECIFIED (F33.9) 5/5/21 Secondary 9 Or More Admitting Dx (69) ANEMIA, UNSPECIFIED (D64.9) 5/4/21 Secondary 9 Or More Admitting Dx (69) CAROTID ARTERY SYNDROME (HEMISPHERIC) (G45.1) 5/4/21 Secondary 9 Or More Admitting Dx (69) CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED (N18.30) 5/4/21 Secondary 9 Or More Admitting Dx (69) GENERALIZED ANXIETY DISORDER (F41.1) 5/4/21 Secondary 9 Or More Admitting Dx (69) IRRITABLE BOWEL SYNDROME WITH CONSTIPATION (K58.1) 5/4/21 Secondary 9 Or More Admitting Dx (69) METABOLIC DISORDER, UNSPECIFIED (E88.9) 5/4/21 Secondary 9 Or More Admitting Dx (69) MIXED HYPERLIPIDEMIA (E78.2) 5/4/21 Secondary 9 Or More Admitting Dx (69) MORBID (SEVERE) OBESITY DUE TO EXCESS CALORIES (E66.01) 5/4/21 Secondary 9 Or More Admitting Dx (69) OSTEOPATHY IN DISEASES CLASSIFIED ELSEWHERE, UNSPECIFIED SITE (M90.80) 5/4/21 Secondary 9 Or More Admitting Dx (69) POLYOSTEOARTHRITIS, UNSPECIFIED (M15.9) 5/4/21 Secondary 9 Or More Admitting Dx (69) POSTMENOPAUSAL ATROPHIC VAGINITIS (N95.2) 5/4/21 Secondary 9 Or More Admitting Dx (69) SPINAL STENOSIS, SITE UNSPECIFIED (M48.00) 5/4/21 Secondary 9 Or More Admitting Dx (69) STRESS INCONTINENCE (FEMALE) (MALE) (N39.3) 5/4/21 Se
Preexisting Conditions: UNSPECIFIED ATRIAL FIBRILLATION (I48.91) 5/4/21 Primary/Principal/Admission (67) Primary/Principal/Admission SHORTNESS OF BREATH (R06.02) 5/4/21 Secondary #1 Admitting Dx (69) CHRONIC COMBINED SYSTOLIC (CONGESTIVE) AND DIASTOLIC (CONGESTIVE) HEART FAILURE (I50.42) 5/4/21 Secondary #2 Admitting Dx (69) MUSCLE WEAKNESS (GENERALIZED) (M62.81) 5/5/21 Secondary #3 Admitting Dx (69) UNSTEADINESS ON FEET (R26.81) 5/5/21 Secondary #4 Admitting Dx (69) NEED FOR ASSISTANCE WITH PERSONAL CARE (Z74.1) 5/5/21 Secondary #5 Admitting Dx (69) HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE WITH HEART FAILURE AND STAGE 1 THROUGH STAGE 4 CHRONIC KIDNEY DISEASE, OR UNSPECIFIED CHRONIC KIDNEY DISEASE (I13.0) 5/4/21 Secondary #6 Admitting Dx (69) TYPE 2 DIABETES MELLITUS WITH HYPERGLYCEMIA (E11.65) 5/4/21 Secondary #7 Admitting Dx (69) DYSPHAGIA, UNSPECIFIED (R13.10) 8/1/21 Secondary 9 Or More During Stay KLEBSIELLA PNEUMONIAE [K. PNEUMONIAE] AS THE CAUSE OF DISEASES CLASSIFIED ELSEWHERE (B96.1) 7/19/21 Secondary 9 Or More During Stay URINARY TRACT INFECTION, SITE NOT SPECIFIED (N39.0) 7/19/21 Secondary 9 Or More During Stay OTHER SYMBOLIC DYSFUNCTIONS (R48.8) 7/16/21 Secondary 9 Or More During Stay ALLERGY STATUS TO UNSPECIFIED DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES (Z88.9) 6/1/21 Secondary 9 Or More CONSTIPATION, UNSPECIFIED (K59.00) 5/5/21 Secondary 9 Or More Admitting Dx (69) HYPOTHYROIDISM, UNSPECIFIED (E03.9) 5/5/21 Secondary 9 Or More Admitting Dx (69) INSOMNIA, UNSPECIFIED (G47.00) 5/5/21 Secondary 9 Or More Admitting Dx (69) MAJOR DEPRESSIVE DISORDER, RECURRENT, UNSPECIFIED (F33.9) 5/5/21 Secondary 9 Or More Admitting Dx (69) ANEMIA, UNSPECIFIED (D64.9) 5/4/21 Secondary 9 Or More Admitting Dx (69) CAROTID ARTERY SYNDROME (HEMISPHERIC) (G45.1) 5/4/21 Secondary 9 Or More Admitting Dx (69) CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED (N18.30) 5/4/21 Secondary 9 Or More Admitting Dx (69) GENERALIZED ANXIETY DISORDER (F41.1) 5/4/21 Secondary 9 Or More Admitting Dx (69) IRRITABLE BOWEL SYNDROME WITH CONSTIPATION (K58.1) 5/4/21 Secondary 9 Or More Admitting Dx (69) METABOLIC DISORDER, UNSPECIFIED (E88.9) 5/4/21 Secondary 9 Or More Admitting Dx (69) MIXED HYPERLIPIDEMIA (E78.2) 5/4/21 Secondary 9 Or More Admitting Dx (69) MORBID (SEVERE) OBESITY DUE TO EXCESS CALORIES (E66.01) 5/4/21 Secondary 9 Or More Admitting Dx (69) OSTEOPATHY IN DISEASES CLASSIFIED ELSEWHERE, UNSPECIFIED SITE (M90.80) 5/4/21 Secondary 9 Or More Admitting Dx (69) POLYOSTEOARTHRITIS, UNSPECIFIED (M15.9) 5/4/21 Secondary 9 Or More Admitting Dx (69) POSTMENOPAUSAL ATROPHIC VAGINITIS (N95.2) 5/4/21 Secondary 9 Or More Admitting Dx (69) SPINAL STENOSIS, SITE UNSPECIFIED (M48.00) 5/4/21 Secondary 9 Or More Admitting Dx (69) STRESS INCONTINENCE (FEMALE) (MALE) (N39.3) 5/4/21 Se
Allergies: Carbidopa, Etodolac, Iodine I 131 Tositumomab, Lovastatin, Metformin, Oxycodone, Cipro, Demerol, Januvia, Levaquin, Nexium, Valium, Vioxx, Sulfa Antibiotics
Diagnostic Lab Data: STAT chest xray, STAT EKG, STAT BNP and to obtain rapid COVID 19 test- 09/10/2021
CDC Split Type:

Write-up: Resident not feeling well, very anxious, wants to go to hospital. All VS stable and WNL, BS 126. Family states resident has behavior like this when she has a UTI. she does have upper airway wheezes and bilateral lower lobe crackles, oxygen increased to 3LPM and is @ 96% whereas when she was on 1LPM she was Sat @ 86%. Residents skin color is very pale, she is lethargic and complaining of nausea and fatigue at this time. EKG done at this time per facility machine. Report reads as follows: atrial fibrillation with rapid mean ventricular response minor high-lateral and lateral repolarization disturbance, consider ischemia, LV overload or aspecific change, abnormal ECG, unconfirmed report. Dr. B returned call, requesting that EKG be uploaded into PCC, EKG was uploaded per request. Dr. B called the center and spoke to this writer, new orders to give additional one time dose of lasix 80mg now and then hold her 60mg dose of lasix in the morning and give her 80mg instead. Then resume normal dosing.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1693455


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166