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

This is VAERS ID 1768345

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Case Details

VAERS ID: 1768345 (history)  
Form: Version 2.0  
Age: 75.0  
Sex: Male  
Location: Michigan  
   Days after vaccination:226
Submitted: 0000-00-00
Entered: 2021-10-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, COVID-19, Chest X-ray normal, Condition aggravated, Dysstasia, Fatigue, Gait disturbance, Loss of personal independence in daily activities, Pyrexia, SARS-CoV-2 test positive
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen (TYLENOL) 500 MG tablet aspirin EC 81 MG enteric coated tablet citalopram (CELEXA) 40 MG tablet cycloSPORINE (RESTASIS) 0.05 % ophthalmic emulsion Ferrous Sulfate (IRON) 325 (65 Fe) MG TABS furosemide (LASIX) 20 MG tablet Gluc
Current Illness: NA
Preexisting Conditions: Obstructive sleep apnea treated with BiPAP OA (osteoarthritis) Peripheral neuropathy Allergic rhinitis Hypercholesterolemia Essential hypertension Morbid obesity (HCC) Insomnia Alcohol abuse Dry eye syndrome, bilateral Persistent atrial fibrillation and atypical atrial flutter Diabetes mellitus type 2 without retinopathy (HCC) Regular astigmatism, bilateral Substance abuse (HCC) History of GI bleed Nonischemic cardiomyopathy Depression, major, recurrent, mild (HCC) PMR (polymyalgia rheumatica) (HCC) Lower extremity edema Primary osteoarthritis of left hip SSS (sick sinus syndrome) (HCC) Status post biventricular cardiac pacemaker insertion, 02/05/2019 Chronic coronary artery disease Chronic obstructive pulmonary disease (HCC) Chronic pain Central sleep apnea Nocturnal hypoxia Ocular hypertension, bilateral Former smoker 100 pack year history Right upper Lung nodule Unable to ambulate Lactic acidosis Prolonged Q-T interval on ECG Choledocholithiasis Cholangitis Mild left ventricular systolic dysfunction (EF 0.50) Status post catheter radiofrequency ablation of atrial fibrillation x 2 History of multiple cardioversions S/P AV (atrioventricular) nodal ablation, 02/05/2019 Deep vein thrombosis bilateral gastrocnemius veins, 02/02/2020 Obesity (BMI 30-39.9) Presence of Watchman left atrial appendage closure device 02/13/2018 Hepatic steatosis Moderate protein-calorie malnutrition (HCC) Multiple lung nodules on CT Biventricular cardiac pacemaker in situ Squamous blepharitis of upper and lower eyelids of both eyes Type 2 diabetes mellitus with hyperglycemia (HCC) Gastroesophageal reflux disease without esophagitis Alcohol-induced chronic pancreatitis (HCC) Atherosclerosis of aorta (HCC) Polyneuropathy in other diseases classified elsewhere (HCC) Major depressive disorder, recurrent episode, moderate (HCC) Ataxic gait Chronic bilateral low back pain without sciatica Generalized weakness COVID-19
Allergies: Lisinopril Swelling
Diagnostic Lab Data:
CDC Split Type:

Write-up: Hospitalized (9.30.21); COVID-19 positive (9.30.21); fully vaccinated Discharge Provider: DO Primary Care Provider at Discharge: MD Admission Date: 9/30/2021 Discharge Date: 10/02/2021 PRESENTING PROBLEM: Weakness [R53.1] Generalized weakness [R53.1] COVID-19 [U07.1] HOSPITAL COURSE: Patient is a 76 year old male with history of NICM, SSS s/p PPM, A-Fib/Flutter s/p Watchman, prior DVT, HTN, HLD, T2DM with chronic neuropathy, alcohol use with hepatic steatosis, pancreatic insufficiency, COPD, OSA, depression and RLS who presented to the ER with generalized weakness. Patient reported normally performing ADLs with occasional assistance from family, however lately had been so weak he had difficulty standing and ambulating. He denied subjective fevers/chills, however noted to have fever by EMS. In the ER, he was febrile, not hypoxic, and tested positive for COVID 19. CXR was negative for infiltrate. He was admitted under observation for further monitoring. Patient qualified for monoclonal antibody infusion which was given. He did not qualify for Remdesivir or Decadron with negative CXR and no hypoxia. Patient worked with PT/OT who did not identify any needs for him at home. The following day, patient felt much better. He denied shortness of breath, fever. He continued to have fatigue, but overall improved. He was ambulated multiple times by PT and found to not be hypoxic/needing home O2. He was discharged to home in improving condition on 10/3/21.

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