National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/19/2021 release of VAERS data:

This is VAERS ID 1765873

Government Disclaimer on use of this data



Case Details

VAERS ID: 1765873 (history)  
Form: Version 2.0  
Age: 90.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-02-04
Onset:2021-10-04
   Days after vaccination:242
Submitted: 0000-00-00
Entered: 2021-10-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 AR / IM
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EM9810 / 2 AR / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Brain natriuretic peptide increased, COVID-19, Cardiac failure congestive, Chest X-ray abnormal, Chronic kidney disease, Condition aggravated, Dyspnoea, Fatigue, Hyperkalaemia, Hypophagia, Hypoxia, Pleural effusion, Pneumonia, SARS-CoV-2 test positive, Troponin increased
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Systemic lupus erythematosus (broad), Myocardial infarction (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (narrow), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), 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, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet acyclovir (ZOVIRAX) 400 MG tablet apixaban (ELIQUIS) 2.5 MG tablet Calcium Carb-Cholecalciferol (CALCIUM + D3) 600-800 MG-UNIT TABS ferrous sulfate 325 (65 Fe) MG delayed release tablet folic acid (FOLV
Current Illness:
Preexisting Conditions: A-fib (HCC) Acute diastolic CHF (congestive heart failure) (HCC) Aortic valve insufficiency Arthritis CAD (coronary artery disease) Cancer (HCC) Colon cancer (HCC) Congestive heart failure (HCC) Coronary artery disease Detrusor instability of bladder Glaucoma History of blood transfusion HTN (hypertension) Hyperlipidemia Hypertension Laryngitis Macrocytic anemia Macular degeneration MD (muscular dystrophy) (HCC) Neck pain Nocturia Polymyalgia rheumatica (HCC) Severe tricuspid valve insufficiency
Allergies: Ivp Dye, Iodine, Tramadol and Vicodin (hydrocodone-acetaminophen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized 10/4/2021; COVID-19 Positive 10/04/2021; fully vaccinated CHIEF COMPLAINT: COVID-19 Assessment/Plan HISTORY OF PRESENT ILLNESS: Pt is a 91 y.o. male who presented yesterday for evaluation of shortness of breath, fatigue and poor po intake. He was treated for pneumonia in September but recovered from that infection with antibiotics. He had several weeks of feeling well before starting to feel symptoms again the past week (not sure of date). Has family recently diagnosed with covid as well. Follows with cardiology for CHF and valvular heart disease. In the ER, Pt was hypoxic on RA. He required o2 via NC. Labs showed an elevated BNP, hyperkalemia, his known CKD and an elevated troponin. COVID-19 was positive. Chest xray showed CHF with a moderate right pleural effusion. He was started on Decadron and lasix with significant improvement. Initially, we did not have beds to accept him so he was pending transfer but was later admitted to HCF. Denies chest pain. Afebrile. Care Management note 10/6/2021: Plan/Reassessment: Plan Discharge Coordination/Progress: Pt plans to return home with family supports. He denies need for further services Plan: return home. Patient-Specific Goals (Include Timeframe): return home 1-2 days


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1765873


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166