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

This is VAERS ID 916538

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Case Details

VAERS ID: 916538 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Washington  
Vaccinated:2020-12-28
Onset:2020-12-28
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-31
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Base excess, Basophil count decreased, Basophil percentage decreased, Blood bicarbonate normal, Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood pH increased, Blood potassium decreased, Blood sodium normal, Blood urea normal, Carbon dioxide decreased, Chest X-ray normal, Dysphagia, Dyspnoea, Electrocardiogram T wave abnormal, Electrocardiogram abnormal, Eosinophil count decreased, Eosinophil percentage decreased, Granulocyte count, Granulocyte percentage, Haematocrit normal, Haemoglobin normal, Hyperhidrosis, Injection site erythema, Lymphocyte count increased, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume normal, Monocyte count normal, Monocyte percentage decreased, Muscle rigidity, Neutrophil count increased, Neutrophil percentage increased, Opisthotonus, PCO2 decreased, PO2 decreased, Pharyngeal swelling, Platelet count normal, Rash macular, Rash pruritic, Red blood cell count normal, Red blood cell nucleated morphology, Red cell distribution width normal, Sensory disturbance, Skin warm, Tachypnoea, Tremor, Troponin I normal, White blood cell count increased
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Asthma/bronchospasm (broad), Haematopoietic leukopenia (narrow), Lactic acidosis (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (narrow), Parkinson-like events (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (broad), Hypersensitivity (narrow), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Hypokalaemia (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: iron 65 mg BID, super B-complex once daily, flax seed oil 1,000 mg daily, vitamin C 500 mg BID, vitamin D3 2,000 IU daily, Zyrtec 10 mg daily for nasal congestion seasonal allergies acyclovir, buspirone, Wellbutrin, hydroxyzine 10 mg prn a
Current Illness: Did have nasal congestion in November briefly and then again in early December. Did get covid tests each time which were negative. Was feeling fine at the time of her vaccine.
Preexisting Conditions: anxiety, hx of depression, hx of herpes, takes acyclovir for suppression, hx of cholecystectomy
Allergies: none, did develop seasonal nasal congestion this year.
Diagnostic Lab Data: pH Venous 7.33 - 7.43 7.43 pCO2 Venous 39 - 54 mm/Hg 35Low pO2 Venous 25 - 43 mm/Hg 39 HCO3 Venous 24 - 28 mmol/L 22Low BE Venous -3.0 - 3.0 mmol/L -1.2 O2 Sat Ven (Cal) 60 - 85 % 77 Device Room Air Ref Range & Units 12/29/20 3:22 PM Troponin I <=0.03 ng/mL <0.02 Comment: 0.03 ng/mL or less: No detectable cardiac injury 0.04 to 0.49 ng/mL: Possible Cardiac muscle injury 0.50 ng/mL or greater: Myocardial infarction Serial testing is highly recommended with a Troponin of 0.04 ng/mL or greater. Sodium 136 - 145 mmol/L 140 Potassium 3.6 - 5.0 mmol/L 3.4Low Chloride 98 - 107 mmol/L 106 Carbon Dioxide 22 - 28 mmol/L 22 BUN 6 - 20 mg/dL 12 Creatinine 0.60 - 1.10 mg/dL 0.67 Glucose 74 - 100 mg/dL 134High Calcium 8.6 - 10.3 mg/dL 9.3 WBC 4.00 - 10.00 x10''3/uL 15.78High RBC 3.85 - 5.20 x10''6/uL 4.43 Hemoglobin 11.5 - 16.0 gm/dL 13.7 Hematocrit 34.7 - 46.0 % 40.8 MCV 80.0 - 97.0 fL 92.1 MCH 26.0 - 34.0 pg 30.9 MCHC 32.0 - 36.0 gm/dL 33.6 RDW 11.5 - 15.0 % 12.0 Platelet Count 140 - 440 x10''3/uL 345 MPV 6.5 - 12.4 fL 9.1 Auto % Neut 37.0 - 80.0 % 91.7High Auto % Lymph 16.0 - 51.0 % 6.1Low Auto % Mono 0.0 - 12.0 % 1.7 Auto % Eos 0.0 - 8.0 % 0.0 Auto % Baso 0.0 - 3.0 % 0.1 Auto % Imm Gran 0.0 - 1.0 % 0.4 Comment: Immature granulocytes are composed of metamyelocytes, myelocytes, and promyelocytes; bands and blasts are not included. Auto % NRBC 0.0 - 0.2 /100 WBC 0.0 Auto ABS Neut 1.50 - 8.00 x10''3/uL 14.46High Auto ABS Lymph 0.80 - 4.00 x10''3/uL 0.97 Auto ABS Mono 0.00 - 1.20 x10''3/uL 0.27 Auto ABS Eos 0.00 - 0.30 x10''3/uL 0.00 Auto ABS Baso 0.00 - 0.30 x10''3/uL 0.02 Auto ABS Imm Gran 0.00 - 0.10 x10''3/uL 0.06 Auto ABS NRBC 0.00 - 0.01 x10''3/uL 0.00 VENT RATE 94 BPM ATRIAL RATE 94 BPM PR INTERVAL 140 ms QRS DURATION 82 ms QT INTERVAL 368 ms QTC 460 ms P AXIS 62 degrees R AXIS 34 degrees T AXIS 11 degrees Result Narrative Normal sinus rhythm T wave abnormality, consider anterior ischemia Abnormal ECG No previous ECGs available normal cxr
CDC Split Type:

Write-up: 15-20 mins after receiving the vaccine she reported she had difficulty swallowing and difficulty breathing and was ?shaking." a PA wrote in her note that when she ran in to help, she found the patient to be tachypneic, diaphoretic, warm with some red blotchy patches on face, chest & neck. Able to speak easily c/o trouble breathing & sensation of throat swelling & extremities feeling abnormal. No stridor. No facial edema noted by that clinician. Administered epi-pen 0.3mg - IV started , Benadryl 50mg IVP and solumedrol 125mg IVP. Patient reports she subsequently arched her back and had rigidity of her arms/legs and tremors. Clinic PA reports that while she was there, pt was never hypotensive. Initially hypertensive after epi as expected with some favorable response after 10-15 min Staff there gave her IM epinephrine, IV Solu-Medrol and 50 mg IV Benadryl. EMS was contacted and transported to the emergency room. She arrived at the ER, was monitored for 2 hours, was started on pepcid and benadryl and discharged from the ER. She had a diffuse itchy rash. The following day she again developed recurrence of throat swelling. Went back to a different ER. Developed dyspnea immediately prior to arrival at ER. There was again given solumedrol and benadryl and pepcid and developed muscle rigidity and arched back for 10 minutes. Symptoms of SOB and dyspnea resolved with epinephrine. Was discharged from the ER with prednisone after being monitored for 5 hours. Is continuing to take prednisone and benadryl. Rash is still present but improving with scheduled benadryl. Has new redness at injection site today. Continues to feel some throat swelling but no tightness today. This information was gathered from talking with pt today for a phone appt and also from her medical chart regarding her vaccination visit and two ER visits.


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