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From the 6/11/2021 release of VAERS data:

This is VAERS ID 903931



Case Details

VAERS ID: 903931 (history)  
Form: Version 2.0  
Age: 29.0  
Sex: Male  
Location: Washington  
Vaccinated:2020-12-17
Onset:2020-12-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / SYR

Administered by: Military       Purchased by: ?
Symptoms: Abdominal pain, Blood creatinine increased, C-reactive protein increased, Computerised tomogram abdomen, Computerised tomogram abnormal, Dehydration, Gastrointestinal inflammation, Gastrointestinal wall thickening, Haematocrit increased, Scan with contrast abnormal, Small intestinal obstruction
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal obstruction (narrow), Gastrointestinal nonspecific inflammation (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Ischaemic colitis (broad), Chronic kidney disease (broad), Noninfectious diarrhoea (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Denies any home medications
Current Illness: None
Preexisting Conditions: None
Allergies: Denies any allergies
Diagnostic Lab Data: 12/18/20 - CT Abdomen and Pelvis w/ Contrast
CDC Split Type:

Write-up: Presented with periumbilical pain to emergency department (patient works at Medical Center). Admitted to hospital for small bowel obstruction. Labs were consistent with dehydration (Hct 55, Cr 1.25), as well as CRP 1.10. A CT Abd/Pelvis identified proximal dilation and fecalization of small bowel, with a transition point in the left lower quadrant. Distal to the transition point, the small bowel appears thick, with hyperenhancement and inflammation progressing into the cecum. General Surgery was consulted and patient admitted to hospital for management of this small bowel obstruction.


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