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This is VAERS ID 917961

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History of Changes from the VAERS Wayback Machine

First Appeared on 1/7/2021

VAERS ID: 917961
VAERS Form:2
Age:54.0
Sex:Male
Location:California
Vaccinated:2020-12-31
Onset:2020-12-31
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: Aphasia, Arteriogram carotid, Blood magnesium, Blood thyroid stimulating hormone, C-reactive protein, Chest X-ray, Culture urine, Differential white blood cell count, Dyspnoea, Dyspnoea exertional, Electrocardiogram, Fibrin D dimer, Full blood count, Glycosylated haemoglobin, Lipids, Platelet count, Tachycardia, Tachypnoea, Ultrasound kidney, Urine analysis, Red blood cell sedimentation rate, Troponin I, Angiogram cerebral, Brain natriuretic peptide, Computerised tomogram head, Scan with contrast, Metabolic function test, Respiratory viral panel, Perfusion brain scan, Magnetic resonance imaging brain, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     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


Changed on 5/7/2021

VAERS ID: 917961 Before After
VAERS Form:2
Age:54.0
Sex:Male
Location:California
Vaccinated:2020-12-31
Onset:2020-12-31
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: Aphasia, Arteriogram carotid, Blood magnesium, Blood thyroid stimulating hormone, C-reactive protein, Chest X-ray, Culture urine, Differential white blood cell count, Dyspnoea, Dyspnoea exertional, Electrocardiogram, Fibrin D dimer, Full blood count, Glycosylated haemoglobin, Lipids, Platelet count, Tachycardia, Tachypnoea, Ultrasound kidney, Urine analysis, Red blood cell sedimentation rate, Troponin I, Angiogram cerebral, Brain natriuretic peptide, Computerised tomogram head, Scan with contrast, Metabolic function test, Respiratory viral panel, Perfusion brain scan, Magnetic resonance imaging brain, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     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 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


Changed on 5/14/2021

VAERS ID: 917961 Before After
VAERS Form:2
Age:54.0
Sex:Male
Location:California
Vaccinated:2020-12-31
Onset:2020-12-31
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: Aphasia, Arteriogram carotid, Blood magnesium, Blood thyroid stimulating hormone, C-reactive protein, Chest X-ray, Culture urine, Differential white blood cell count, Dyspnoea, Dyspnoea exertional, Electrocardiogram, Fibrin D dimer, Full blood count, Glycosylated haemoglobin, Lipids, Platelet count, Tachycardia, Tachypnoea, Ultrasound kidney, Urine analysis, Red blood cell sedimentation rate, Troponin I, Angiogram cerebral, Brain natriuretic peptide, Computerised tomogram head, Scan with contrast, Metabolic function test, Respiratory viral panel, Perfusion brain scan, Magnetic resonance imaging brain, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     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 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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