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This is VAERS ID 1761030

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First Appeared on 10/8/2021

VAERS ID: 1761030
VAERS Form:2
Location:New Jersey
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cough, Dyspnoea, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: amiodarone 200 mg Tablet Directions: 1 tablet oral daily (Active) amLODIPine (NorvASC) 5 mg Tablet Directions: 1 tablet oral daily (Active) clopidogrel 75 mg Tablet Directions: 1 tablet oral daily (Active) famotidine (Pepcid) 20 mg
Current Illness:
Preexisting Conditions: CAD, COPD COPD, O2 dependent; Depression, Diabetes, GERD, HTN, Obesity; Other History of Polyp of Colon, Insomnia, Anxiety Disorder. CABG done at Medical Center within the past month; Tracheostomy; Other Cardiac Catheterization, Colonoscopic Polypectomy, Hx CAD w/ Stent Placement, PEG Tube Maintenance. Smoking Status Former Smoker.
Allergies: Codeine, penicillin, azithromycin.
Diagnostic Lab Data: 10/2/21, SARS-CoV-2 PCR (POSITIVE).
CDC 'Split Type':

Write-up: 71-year-old female with h/o COPD, CAD, HTN ,a.fib receved her 2nd dose of covid vaccine in may. started with cough sob hence brought into ED. tested postive for covid

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