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

This is VAERS ID 1750417

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Case Details

VAERS ID: 1750417 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Female  
Location: Hawaii  
Vaccinated:2021-09-29
Onset:2021-09-30
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH FF2587 / 3 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase increased, Aspartate aminotransferase increased, Asthenia, Blood alkaline phosphatase increased, Blood bilirubin increased, Blood chloride decreased, Blood lactic acid, Blood potassium decreased, Blood sodium normal, Blood urea increased, Carbon dioxide decreased, Haemoglobin decreased, Hypotension, Lactic acidosis, Leukocytosis, Liver function test increased, Lymphocyte percentage decreased, Nausea, Neutrophil percentage increased, Platelet count decreased, White blood cell count increased
SMQs:, Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Anaphylactic reaction (broad), Acute pancreatitis (narrow), Haematopoietic erythropenia (broad), Haematopoietic leukopenia (broad), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Biliary system related investigations, signs and symptoms (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Hypokalaemia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Aspirin 81mg PO QD Atorvastatin 80mg PO QD Epoietin 50mcg IV Q4 weeks Furosemide 80mg PO BID Gabapentin 300mg PO BID Sevelamer 1600mg PO TID Nephrovite 1 tab PO QD
Current Illness: COVID infection (Symptom onset 8/27/21)
Preexisting Conditions: HTN HLD DM2 ESRD on HD Anemia Secondary hyperparathyroidism
Allergies: None
Diagnostic Lab Data: 9/30/21 Hb: 10.8 WBC: 27.8 (10% bands, 82% neutrophils, 3% lymphocytes) Platelet: 95 Na: 138 K: 2.9 Cl: 96 CO2: 21 BUN: 55 AST: 933 ALT: 774 Alk Phos: 232 T-bili: 2.4 Lactate: 6.8
CDC Split Type:

Write-up: Adverse events: Hypotension, Lactic acidosis, Leukocytosis, Elevated LFTs Symptoms: Weakness, nausea Treatment: Vancomycin, Zosyn, Pressors


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