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From the 11/12/2021 release of VAERS data:

This is VAERS ID 1745112

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Case Details

VAERS ID: 1745112 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-24
Onset:2021-09-03
   Days after vaccination:163
Submitted: 0000-00-00
Entered: 2021-09-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 044A21A / 2 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Acute kidney injury, Alanine aminotransferase increased, Anion gap normal, Anti factor Xa assay normal, Anticoagulant therapy, Aspartate aminotransferase increased, Asthenia, Atrioventricular block complete, Basophil count, Bilirubin conjugated increased, Blood alkaline phosphatase normal, Blood bicarbonate decreased, Blood bilirubin increased, Blood calcium decreased, Blood chloride normal, Blood creatine increased, Blood gases abnormal, Blood glucose normal, Blood magnesium normal, Blood pH decreased, Blood phosphorus normal, Blood potassium normal, Blood pressure abnormal, Blood pressure systolic decreased, Blood sodium decreased, Blood urea increased, Body temperature decreased, Brain natriuretic peptide increased, C-reactive protein increased, COVID-19, COVID-19 pneumonia, Carbon dioxide normal, Cardiac arrest, Cardiac failure, Cardiac resynchronisation therapy, Cardiac vein dissection, Chest X-ray abnormal, Condition aggravated, Cough, Death, Delirium, Diarrhoea, Dyspnoea, Endotracheal intubation, Eosinophil count, Fibrin D dimer increased, General physical health deterioration, Glomerular filtration rate, Haematocrit decreased, Haemoglobin decreased, Haemoptysis, Hypotension, Hypoxia, Hypoxic-ischaemic encephalopathy, Immature granulocyte count, Implantable defibrillator insertion, Intensive care, International normalised ratio normal, Ischaemic cardiomyopathy, Laboratory test abnormal, Lymphocyte count decreased, Mean cell volume normal, Mental status changes, Metabolic acidosis, Metabolic encephalopathy, Monocyte count, Neutrophil count increased, Neutrophil percentage increased, Oxygen saturation decreased, PCO2, PO2 decreased, Platelet count decreased, Prothrombin time prolonged, Pulseless electrical activity, Red blood cell count decreased, Red blood cell nucleated morphology present, Red cell distribution width increased, Respiratory failure, Resuscitation, Sputum abnormal, Troponin I increased, White blood cell count increased
SMQs:, Torsade de pointes/QT prolongation (broad), Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (narrow), Liver related investigations, signs and symptoms (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (broad), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Ischaemic central nervous system vascular conditions (narrow), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (narrow), 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), Pseudomembranous colitis (broad), Acute central respiratory depression (narrow), Biliary system related investigations, signs and symptoms (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (narrow), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Hypertension (broad), Cardiomyopathy (narrow), Eosinophilic pneumonia (broad), Cardiac arrhythmia terms, nonspecific (narrow), Other ischaemic heart disease (narrow), Chronic kidney disease (broad), Hypersensitivity (broad), Noninfectious diarrhoea (narrow), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 0000-00-00
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Losartan (COZAAR) 25 mg Oral Tab Take 1 tablet by mouth daily ? Furosemide (LASIX) 20 mg Oral Tab Take one-half tablet by mouth daily in the morning. May increase to 1 tablet for sudden weight gain and more shortness of breath ? Tamsulosin
Current Illness: None known
Preexisting Conditions: PMH of CHF (EF 20%), hypertension, anemia, seizures, renal calculus s/p ureteral stents placement and removal
Allergies: NKA
Diagnostic Lab Data: Results for patient as of 9/29/2021 10:27 9/9/2021 07:00 NA: 138 K: 4.5 CL: 99 (L) CO2: 23 (L) BUN: 82 (H) CREAT: 2.72 (H) ANION GAP4 SERPL: 16 CA: 7.8 (L) MG: 2.0 PHOS: 4.8 (H) GLUC: 136 ALT: 115 (H) AST: 108 (H) ALKP: 62 TBILI: 1.5 (H) BILID: 0.6 (H) COMMENT, GLOMERULAR FILTRATION RATE: SEE NOTE CRP, SER QL: 9.7 (H) WBC: 13.7 (H) RBC''S: 3.51 (L) HGB: 10.2 (L) HCT: 31.7 (L) MCV: 90 RDW, RBC: 17.2 (H) PLT: 139 (L) IMMAT GRANULO % AUTO: 1 NRBC: 1 (H) NEUTROPHILS % AUTO: 89 (H) ANC: 12.2 (H) LYMPHS % AUTO: 4 (L) MONOS % AUTO: 5 EOS % AUTO: 0 BASO''S % AUTO: 0 D-DIMER: 0.56 (H) 9/9/2021 09:43 ANTI XA, HEP UNFR: 1.06 (AA) 9/9/2021 23:34 XR CHEST: Rpt 9/10/2021 07:05 NA: 136 K: 4.4 CL: 99 (L) CO2: 25 BUN: 96 (H) CREAT: 2.70 (H) ANION GAP4 SERPL: 12 GLUC: 158 ALT: 120 (H) AST: 77 (H) ALKP: 66 TBILI: 1.1 COMMENT, GLOMERULAR FILTRATION RATE: SEE NOTE WBC: 8.9 RBC''S: 3.41 (L) HGB: 9.9 (L) HCT: 30.8 (L) MCV: 90 RDW, RBC: 16.6 (H) PLT: 124 (L) IMMAT GRANULO % AUTO: 0 NRBC: 1 (H) NEUTROPHILS % AUTO: 90 (H) ANC: 7.9 LYMPHS % AUTO: 4 (L) MONOS % AUTO: 6 EOS % AUTO: 0 BASO''S % AUTO: 0 9/11/2021 00:15 ANTI XA, HEP UNFR: <0.10 9/11/2021 07:21 NA: 132 (L) K: 4.7 CL: 96 (L) CO2: 24 BUN: 102 (H) CREAT: 2.79 (H) ANION GAP4 SERPL: 12 MG: 2.3 GLUC: 159 ALT: 76 (H) AST: 34 ALKP: 80 TBILI: 1.1 COMMENT, GLOMERULAR FILTRATION RATE: SEE NOTE CRP, SER QL: 6.1 (H) WBC: 13.3 (H) RBC''S: 3.69 (L) HGB: 10.9 (L) HCT: 33.0 (L) MCV: 89 RDW, RBC: 16.8 (H) PLT: 101 (L) NRBC: 2 (H) PT: 19.6 (H) INR: 1.7 D-DIMER: $g4.00 (H) ANTI XA, HEP UNFR: 1.24 (AA) 9/11/2021 07:21 WBC: 12.8 (H) RBC''S: 3.62 (L) HGB: 10.4 (L) HCT: 33.3 (L) MCV: 92 RDW, RBC: 16.8 (H) PLT: 107 (L) IMMAT GRANULO % AUTO: 1 NRBC: 2 (H) NEUTROPHILS % AUTO: 92 (H) ANC: 11.8 (H) LYMPHS % AUTO: 3 (L) MONOS % AUTO: 4 (L) EOS % AUTO: 0 BASO''S % AUTO: 0 9/12/2021 07:04 NA: 132 (L) K: 5.0 CL: 97 (L) CO2: 22 (L) BUN: 111 (H) CREAT: 2.84 (H) ANION GAP4 SERPL: 13 MG: 2.3 GLUC: 175 (H) BNP: 3,468 (H) COMMENT, GLOMERULAR FILTRATION RATE: SEE NOTE 9/12/2021 09:58 XR CHEST: Rpt 9/12/2021 14:53 NA: 129 (L) K: 5.3 CL: 96 (L) CO2: 21 (L) BUN: 115 (H) CREAT: 2.99 (H) ANION GAP4 SERPL: 12 GLUC: 195 (H) COMMENT, GLOMERULAR FILTRATION RATE: SEE NOTE 9/13/2021 05:09 TEMP: 96.5 (L) INSPIRED O2: 37 PH CORR VEN BLD: 7.31 (L) PCO2 CORR VEN BLD: 44 PO2 ADJUST TO PT''S TEMP, BLD-V: 36 PH VBLD: 7.30 (L) PVCO2: 47 PO2-V: 39 HCO3-V: 20.3 (L) BE-V: -3.4 (L) SO2, BLDV: 55.3 9/13/2021 07:10 NA: 131 (L) K: 5.1 CL: 96 (L) CO2: 15 (L) BUN: 115 (H) CREAT: 3.12 (H) ANION GAP4 SERPL: 20 (H) MG: 2.7 (H) GLUC: 191 (H) COMMENT, GLOMERULAR FILTRATION RATE: SEE NOTE CRP, SER QL: 2.8 (H) 9/13/2021 07:25 TROPONIN I: 0.12 (H) BNP: 1,926 (H) WBC: 20.8 (H) RBC''S: 4.02 (L) HGB: 11.8 (L) HCT: 38.5 (L) MCV: 96 RDW, RBC: 18.2 (H) PLT: 113 (L) IMMAT GRANULO % AUTO: 1 NRBC: 3 (H) NEUTROPHILS % AUTO: 90 (H) ANC: 18.8 (H) LYMPHS % AUTO: 3 (L) MONOS % AUTO: 5 EOS % AUTO: 0 BASO''S % AUTO: 0 D-DIMER: $g4.00 (H) 9/13/2021 08:15 XR CHEST: Rpt 9/13/2021 08:40 TEMP: 98.6 INSPIRED O2: 100 PH CORR ART BLD: 7.11 (AA) PCO2 CORR ART BLD: 34 (L) PO2 ADJUST TO PT''S TEMP, BLD-A: 95 PH ABLD: 7.11 (AA) PACO2: 34 (L) PO2-A: 95 HCO3 BLD: 11.1 (L) BE BLD: -17.2 (L) SO2, CALCULATED, ARTERIAL: 91.9 (L) 9/13/2021 10:30 TEMP: 98.6 INSPIRED O2: 100 PH CORR ART BLD: 7.13 (AA) PCO2 CORR ART BLD: 51 (H) PO2 ADJUST TO PT''S TEMP, BLD-A: 80 PH ABLD: 7.13 (AA) PACO2: 51 (H) PO2-A: 80 HCO3 BLD: 14.8 (L) BE BLD: -11.2 (L) SO2, CALCULATED, ARTERIAL: 88.4 (L)
CDC Split Type:

Write-up: Reason for Hospital Admission (Admitting Diagnosis): Heart Block/COVID Pneumonia Hospital Course and Significant Findings: 75 Y male with hx of HFrEF (EF: 20%), HTN, anemia, seizures (not on antiepileptics), hx of renal calculus s/p ureteral stents and subsequent removal who presented with shortness of breath, weakness and diarrhea and was found to have AKI, 3rd degree AV block which was diagnosed on 9/5/2021 and COVID diagnosed on 9/3/2021. Dual chamber ICD placed on 9/9 by Dr. (couldn''t get coronary sinus lead in so only RV pacing now). Reattempt LV lead placement is scheduled on 10/18 with Dr. . Stopped heparin gtt and start BID Eliquis (2.5mg BID - discussed dosing with pharmacy) Weight up (standing weight 201lbs today and recorded 188lbs on 9/6), BNP is up, oxygen requirement up today. CXR looked a little better (intermpretation complicated by recent COVID diagnosis). BP is soft (SBP low 90s). Cr and BUN up. D/w Cardiology who recommended start hydralazine, start dopamine gtt, resume Lasix, and consider repeat echo giving finding of dissection of coronary sinus on recent pacemaker placement. With regard to COVID, symptom onset 9/3/2021. COVID positive on 9/3/2021. He remained afebrile. He completed 5 day course of remdesivir and was continued on daily decadron. He was not requiring much oxygen, about 2 to 4LMP via NC and appears well without tachypnea. He had a mild dry cough. He is speaking in complete sentences without cough or tachypnea during my exam. - No hypoxia on 9/11, even with activity, but on 9/12 was a bit hypoxic so was on supplemental oxygen. NONTRAUMATIC AKI on CKD. BUN and Cr increasing. BP was low and CXR looked better but other findings concerning for increasing heart failure. See above for recommendations from cardiology. AMS / Delirium. Due to metabolic and hypoxemic encephalopathy. Fluctuated and occurred the first couple of days during the night. Overnight in the early hours of 9/13, his respiratory status deteriorated. He required increasing oxygen, was seen by cross cover. He started coughing up bloody frothy sputum. Required high flow oxygen. Unfortunately he went into PEA arrest in the morning on 9/13. Required CPR, was resuscitated, intubated and transferred to the ICU. Bedside echo showed diminished EF, no pericardial effusion or tamponade. Per ICU note, "Significant metabolic acidemia an refractory PEA despite initial ROSC and complete resuscitation. Finally, patient was prounced dead at 11am on 9/13." Cause of death: Hypoxic respiratory failure from COVID pneumonia and ischemic cardiomyopathy. Primary Procedures: Procedure(s): CARDIAC AICD TOTAL SYSTEM IMPLANTATION, BIVENTRICULAR CHAMBER


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