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

This is VAERS ID 1762858

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Case Details

VAERS ID: 1762858 (history)  
Form: Version 2.0  
Age: 89.0  
Sex: Female  
Location: Kentucky  
Vaccinated:2021-09-21
Onset:2021-09-30
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH 301358A / 3 RA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Bowel movement irregularity, COVID-19, Dizziness, Dysstasia, Hyperhidrosis, Loss of consciousness, Malaise, Pallor, Palpitations, SARS-CoV-2 test positive
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Noninfectious diarrhoea (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 4 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Sucralfate Tablet 1 GM Give 1 tablet by mouth four times a day related to GASTRO-ESOPHAGEAL REFLUX DISEASE WITH ESOPHAGITIS, WITHOUT BLEEDING (K21.00) Midodrine HCl Tablet 5 MG Give 1 tablet by mouth three times a day for Hypotension ho
Current Illness: OTHER PULMONARY EMBOLISM WITHOUT ACUTE COR PULMONALE (I26.99) 7/30/21 Primary/Principal/Admission (67) Primary/Principal/Admission PAROXYSMAL ATRIAL FIBRILLATION (I48.0) 7/30/21 Secondary #1 Admitting Dx (69) ENCOUNTER FOR SURGICAL AFTERCARE FOLLOWING SURGERY ON THE DIGESTIVE SYSTEM (Z48.815) 7/30/21 Secondary #2 Admitting Dx (69) HYPOKALEMIA (E87.6) 7/30/21 Secondary #3 Admitting Dx (69) OTHER ESOPHAGITIS WITHOUT BLEEDING (K20.80) 7/30/21 Secondary #4 Admitting Dx (69) ADVERSE EFFECT OF UNSPECIFIED DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES, SUBSEQUENT ENCOUNTER (T50.905D) 7/30/21 Secondary #5 Admitting Dx (69) HYPO-OSMOLALITY AND HYPONATREMIA (E87.1) 7/30/21 Secondary #6 Admitting Dx (69) SECONDARY POLYCYTHEMIA (D75.1) 7/30/21 Secondary #8 Admitting Dx (69) COVID-19 (U07.1) 9/24/21 Secondary 9 Or More During Stay PRESSURE ULCER OF LEFT BUTTOCK, STAGE 3 (L89.323) 8/18/21 Secondary 9 Or More During Stay NEED FOR ASSISTANCE WITH PERSONAL CARE (Z74.1) 8/17/21 Secondary 9 Or More Readmission ACUTE POSTHEMORRHAGIC ANEMIA (D62) 8/16/21 Secondary 9 Or More Readmission HYPERTENSIVE CHRONIC KIDNEY DISEASE WITH STAGE 1 THROUGH STAGE 4 CHRONIC KIDNEY DISEASE, OR UNSPECIFIED CHRONIC KIDNEY DISEASE (I12.9) 8/10/21 Secondary 9 Or More Admitting Dx (69) ACUTE KIDNEY FAILURE, UNSPECIFIED (N17.9) 7/30/21 Secondary 9 Or More Admitting Dx (69) ACUTE KIDNEY FAILURE, UNSPECIFIED (N17.9) 7/30/21 8/16/21 Secondary 9 Or More Admitting Dx (69) BANDEMIA (D72.825) 7/30/21 Secondary 9 Or More Admitting Dx (69) BODY MASS INDEX [BMI]40.0-44.9, ADULT (Z68.41) 7/30/21 Secondary 9 Or More Admitting Dx (69) CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED (N18.30) 7/30/21 Secondary 9 Or More Admitting Dx (69) CONSTIPATION, UNSPECIFIED (K59.00) 7/30/21 Secondary 9 Or More Admitting Dx (69) ELEVATED WHITE BLOOD CELL COUNT, UNSPECIFIED (D72.829) 7/30/21 Secondary 9 Or More Admitting Dx (69) ESSENTIAL (HEMORRHAGIC) THROMBOCYTHEMIA (D47.3) 7/30/21 Secondary 9 Or More Admitting Dx (69) GASTRO-ESOPHAGEAL REFLUX DISEASE WITH ESOPHAGITIS, WITHOUT BLEEDING (K21.00) 7/30/21 Secondary 9 Or More Admitting Dx (69) HYPERLIPIDEMIA, UNSPECIFIED (E78.5) 7/30/21 Secondary 9 Or More Admitting Dx (69) HYPOCALCEMIA (E83.51) 7/30/21 Secondary 9 Or More Admitting Dx (69) ILEUS, UNSPECIFIED (K56.7) 7/30/21 Secondary 9 Or More Admitting Dx (69) MORBID (SEVERE) OBESITY DUE TO EXCESS CALORIES (E66.01) 7/30/21 Secondary 9 Or More Admitting Dx (69) MUSCLE WEAKNESS (GENERALIZED) (M62.81) 7/30/21 Secondary 9 Or More Admitting Dx (69) OTHER SPECIFIED DISORDERS OF BLADDER (N32.89) 7/30/21 Secondary 9 Or More Admitting Dx (69) OTHER SYMBOLIC DYSFUNCTIONS (R48.8) 7/30/21 Secondary 9 Or More Admitting Dx (69) UNSPECIFIED OSTEOARTHRITIS, UNSPECIFIED SITE (M19.90) 7/30/21 Secondary 9 Or More Admitting Dx (69) UNSTEADINESS ON FEET (R26.81) 7/30/21 Secondary 9 Or More Admitting Dx (69) VITAMIN B12 DEFICIENCY ANEMIA, UNSPECIFIED (D51.9) 7/30/21 Secondary 9 Or More Admitting Dx (69) VITAMIN D DEFICIENCY, UNSPECIFIED (E55.9) 7/30/21 Secondary 9 Or More Admitting Dx (69)
Preexisting Conditions: OTHER PULMONARY EMBOLISM WITHOUT ACUTE COR PULMONALE (I26.99) 7/30/21 Primary/Principal/Admission (67) Primary/Principal/Admission PAROXYSMAL ATRIAL FIBRILLATION (I48.0) 7/30/21 Secondary #1 Admitting Dx (69) ENCOUNTER FOR SURGICAL AFTERCARE FOLLOWING SURGERY ON THE DIGESTIVE SYSTEM (Z48.815) 7/30/21 Secondary #2 Admitting Dx (69) HYPOKALEMIA (E87.6) 7/30/21 Secondary #3 Admitting Dx (69) OTHER ESOPHAGITIS WITHOUT BLEEDING (K20.80) 7/30/21 Secondary #4 Admitting Dx (69) ADVERSE EFFECT OF UNSPECIFIED DRUGS, MEDICAMENTS AND BIOLOGICAL SUBSTANCES, SUBSEQUENT ENCOUNTER (T50.905D) 7/30/21 Secondary #5 Admitting Dx (69) HYPO-OSMOLALITY AND HYPONATREMIA (E87.1) 7/30/21 Secondary #6 Admitting Dx (69) SECONDARY POLYCYTHEMIA (D75.1) 7/30/21 Secondary #8 Admitting Dx (69) COVID-19 (U07.1) 9/24/21 Secondary 9 Or More During Stay PRESSURE ULCER OF LEFT BUTTOCK, STAGE 3 (L89.323) 8/18/21 Secondary 9 Or More During Stay NEED FOR ASSISTANCE WITH PERSONAL CARE (Z74.1) 8/17/21 Secondary 9 Or More Readmission ACUTE POSTHEMORRHAGIC ANEMIA (D62) 8/16/21 Secondary 9 Or More Readmission HYPERTENSIVE CHRONIC KIDNEY DISEASE WITH STAGE 1 THROUGH STAGE 4 CHRONIC KIDNEY DISEASE, OR UNSPECIFIED CHRONIC KIDNEY DISEASE (I12.9) 8/10/21 Secondary 9 Or More Admitting Dx (69) ACUTE KIDNEY FAILURE, UNSPECIFIED (N17.9) 7/30/21 Secondary 9 Or More Admitting Dx (69) ACUTE KIDNEY FAILURE, UNSPECIFIED (N17.9) 7/30/21 8/16/21 Secondary 9 Or More Admitting Dx (69) BANDEMIA (D72.825) 7/30/21 Secondary 9 Or More Admitting Dx (69) BODY MASS INDEX [BMI]40.0-44.9, ADULT (Z68.41) 7/30/21 Secondary 9 Or More Admitting Dx (69) CHRONIC KIDNEY DISEASE, STAGE 3 UNSPECIFIED (N18.30) 7/30/21 Secondary 9 Or More Admitting Dx (69) CONSTIPATION, UNSPECIFIED (K59.00) 7/30/21 Secondary 9 Or More Admitting Dx (69) ELEVATED WHITE BLOOD CELL COUNT, UNSPECIFIED (D72.829) 7/30/21 Secondary 9 Or More Admitting Dx (69) ESSENTIAL (HEMORRHAGIC) THROMBOCYTHEMIA (D47.3) 7/30/21 Secondary 9 Or More Admitting Dx (69) GASTRO-ESOPHAGEAL REFLUX DISEASE WITH ESOPHAGITIS, WITHOUT BLEEDING (K21.00) 7/30/21 Secondary 9 Or More Admitting Dx (69) HYPERLIPIDEMIA, UNSPECIFIED (E78.5) 7/30/21 Secondary 9 Or More Admitting Dx (69) HYPOCALCEMIA (E83.51) 7/30/21 Secondary 9 Or More Admitting Dx (69) ILEUS, UNSPECIFIED (K56.7) 7/30/21 Secondary 9 Or More Admitting Dx (69) MORBID (SEVERE) OBESITY DUE TO EXCESS CALORIES (E66.01) 7/30/21 Secondary 9 Or More Admitting Dx (69) MUSCLE WEAKNESS (GENERALIZED) (M62.81) 7/30/21 Secondary 9 Or More Admitting Dx (69) OTHER SPECIFIED DISORDERS OF BLADDER (N32.89) 7/30/21 Secondary 9 Or More Admitting Dx (69) OTHER SYMBOLIC DYSFUNCTIONS (R48.8) 7/30/21 Secondary 9 Or More Admitting Dx (69) UNSPECIFIED OSTEOARTHRITIS, UNSPECIFIED SITE (M19.90) 7/30/21 Secondary 9 Or More Admitting Dx (69) UNSTEADINESS ON FEET (R26.81) 7/30/21 Secondary 9 Or More Admitting Dx (69) VITAMIN B12 DEFICIENCY ANEMIA, UNSPECIFIED (D51.9) 7/30/21 Secondary 9 Or More Admitting Dx (69) VITAMIN D DEFICIENCY, UNSPECIFIED (E55.9) 7/30/21 Secondary 9 Or More Admitting Dx (69)
Allergies: NONE
Diagnostic Lab Data: none
CDC Split Type:

Write-up: COVID positive 9-23-2021. 9-30-2021 20:29-aide went to get off toilet. resident stated she didn''t feel good and went to go forward. aide lowered to the ground. resident pale, diaphoretic, resident had on non skid socks. resident had extra large bowel movement at time of episode. resident stated she got light headed and passed out.VS, full assessment, put into bed, notified MD, called family, notified DON, supervisor, UM, intervention: all transfers sit to stand with two assist and PT to evaluate 10-01-2021 08:16am- Resident noted with c/o dizziness unable to stand and c/o heart thumping. VS 120/71, 97.9 115-159, 18 97%ra diaphoretic. Called placed to 911 resident sent out to hospital, called report to ED charge nurse POA is aware and will meet resident at hospital. Resident was A&O at time of transport.


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