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This is VAERS ID 1714480

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First Appeared on 9/24/2021

VAERS ID: 1714480
VAERS Form:2
Age:76.0
Sex:Female
Location:Texas
Vaccinated:2021-09-14
Onset:2021-09-14
Submitted:0000-00-00
Entered:2021-09-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 026C21A / 3 - / -

Administered by: School      Purchased by: ??
Symptoms: Abdominal distension, Anion gap, Asthenia, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood potassium decreased, Blood sodium normal, Blood urea normal, Carbon dioxide decreased, Diarrhoea, Electrocardiogram normal, Fall, Haematocrit decreased, Haemoglobin decreased, Loss of consciousness, Nausea, Syncope, Tibia fracture, Vomiting, Sinus rhythm, Anti-islet cell antibody, Joint injury, Renal function test normal, X-ray limb abnormal, Metabolic function test normal, Extra dose administered

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin; Levetiracetam; Levothyroxine; Lisinopril; Metoprolol Succinate; Ondansetron; Pantoprazole; Sertraline
Current Illness: None
Preexisting Conditions: Bladder Cancer in remission Hypothyroidism, Hyperlipidemia, CVA, Seizure Disorder, Chronic anemia
Allergies: NKDA
Diagnostic Lab Data: Glucose 126; BUN 19; Creatine 0.9; Na 139; K 3.4; cL106; TCO2 21; Angap 17; ICA 1.21; HCT 33; Hb 11.2; EKG demonstrated Normal Sinus Rhythm without ectopy and no ischemic changes.
CDC 'Split Type':

Write-up: Patient received her vaccination on 914. Patient started developing her symptoms that evening including significant abdominal bloating along with diarrhea. Patient had persistent diarrhea the following day along with nausea and vomiting. When walking back from a bowel movement from the restroom the patient had a syncopal episode and was caught by her husband. She had a loss of consciousness for about 30 seconds. She resumed consciousness without complication she had no seizure like activity. She was able to return to her bed. She was evaluated. A basic metal panel was performed she had no evidence of dehydration and had normal renal function. We provided normal saline infusion and Zofran for nausea. Pt had and xray performed for her ankle as she twisted it when she collapsed. She was noted to have a distal tibia fracture. Patient is tolerating food and fluids at this time but still has persistent diarrhea and generalized weakness. She is will be evaluated and treated by orthopedics for her ankle fracture.

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