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

This is VAERS ID 917961

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Case Details

VAERS ID: 917961 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: California  
Vaccinated:2020-12-31
Onset:2020-12-31
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Angiogram cerebral, Aphasia, Arteriogram carotid, Blood magnesium, Blood thyroid stimulating hormone, Brain natriuretic peptide, C-reactive protein, Chest X-ray, Computerised tomogram head, Culture urine, Differential white blood cell count, Dyspnoea, Dyspnoea exertional, Electrocardiogram, Fibrin D dimer, Full blood count, Glycosylated haemoglobin, Lipids, Magnetic resonance imaging brain, Metabolic function test, Perfusion brain scan, Platelet count, Red blood cell sedimentation rate, Respiratory viral panel, SARS-CoV-2 test, Scan with contrast, Tachycardia, Tachypnoea, Troponin I, Ultrasound kidney, Urine analysis
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Respiratory failure (broad), Infective pneumonia (broad), Dehydration (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Symbicort inhaler: 2-puffs / twice daily Metoprolol 25mg: 1-tab / daily Lipitor 80mg: 1-tab / daily Zestril 5mg: 1 tab / daily Brilinta 90mg: 1-tab / twice daily Prilosec 20mg: 1-tab / daily HCTZ 25mg: 1-tab / daily ASA 81mg: 1-tab / daily
Current Illness: June 22,2020: COVID19 positive July 2020: Diagnosed with restrictive airway disease, small airway disease, lung nodules November 11, 2020: STEMI, required angioplasty and stent placement
Preexisting Conditions: HTN Conditions highly related to COVID19 infection per provider: Restrictive airway & small airway disease CAD Depression Anxiety
Allergies: Losartan
Diagnostic Lab Data: BASIC METABOLIC Jan 2, 2021 MAGNESIUM Jan 2, 2021 ECG 12-LEAD Jan 1, 2021 D-DIMER,QUANTITATIVE Jan 1, 2021 TROPONIN I Jan 1, 2021 COMPREHENSIVE METABOLIC PANEL Jan 1, 2021 CBC W/ DIFF Jan 1, 2021 C-REACTIVE PROTEIN Jan 1, 2021 US RENAL COMPLETE Jan 1, 2021 MRI BRAIN WO CONTRAST Jan 1, 2021 TROPONIN I Jan 1, 2021 SEDIMENTATION RATE, AUTOMATED Jan 1, 2021 TSH Jan 1, 2021 LIPID PANEL Jan 1, 2021 HEMOGLOBIN A1C Jan 1, 2021 HEMOGRAM 2 (H&H) Jan 1, 2021 PLATELET COUNT Jan 1, 2021 MAGNESIUM Jan 1, 2021 UA W MICROSCOPIC (C&S IF INDICATED) Jan 1, 2021 CT CEREBRAL PERFUSION Dec 31, 2020 CT ANGIOGRAM HEAD NECK W CONTRAST Dec 31, 2020 CT HEAD WO CONTRAST Dec 31, 2020 XR CHEST AP PORTABLE Dec 31, 2020 ECG 12-LEAD Dec 31, 2020 UPPER RESPIRATORY PATHOGEN PANEL W SARS-COV-2 (COVID-19) Dec 31, 2020 CBC W/ DIFF Dec 31, 2020 COMPREHENSIVE METABOLIC PANEL Dec 31, 2020 ER TROPONIN-I Dec 31, 2020 BNP (NT-PROBNP, NT-PRO B-TYPE NATRIURETIC PEPTIDE) Dec 31, 2020 C-REACTIVE PROTEIN Dec 31, 2020 SEDIMENTATION RATE, AUTOMATED Dec 31, 2020
CDC Split Type:

Write-up: I suffer from lingering SOB with exertion after COVID infection. On the night of 12/31/2020 I began to feel more SOB than usual and was unable to correct my SOB with rescue inhaler. Became more SOB with exacerbated tachycardia and tachypnea, My family had to call 911 because I became aphasic and showing signs of possible stroke. I was taken to the ER and admitted for respiratory recovery and to role out stroke. The stroke was ruled out and I recovered with IV prednisone therapy, twice daily and supplemental oxygen. Released after HR, BP, & respiratory effort returned to normal: 01/03/2021


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