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

This is VAERS ID 919633

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Case Details

VAERS ID: 919633 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2020-01-04
Onset:2020-12-30
   Days after vaccination:361
Submitted: 0000-00-00
Entered: 2021-01-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 037K20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Alanine aminotransferase normal, Angiogram cerebral normal, Anion gap decreased, Arteriogram carotid normal, Aspartate aminotransferase normal, Basophil count normal, Basophil percentage, Blood albumin normal, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium normal, Blood chloride normal, Blood creatinine normal, Blood glucose normal, Blood potassium normal, Blood sodium normal, Blood urea nitrogen/creatinine ratio, Blood urea normal, Carbon dioxide normal, Chest X-ray normal, Computerised tomogram head normal, Electrocardiogram, Eosinophil count normal, Eosinophil percentage, Facial paralysis, Facial paresis, Feeling hot, Glomerular filtration rate, Haematocrit normal, Haemoglobin normal, Hypoaesthesia, Immature granulocyte count increased, Immature granulocyte percentage increased, Immediate post-injection reaction, Injection site hypoaesthesia, Injection site warmth, Lymphocyte count normal, Lymphocyte percentage decreased, Mean cell haemoglobin concentration normal, Mean cell haemoglobin decreased, Mean cell volume normal, Mean platelet volume increased, Monocyte count normal, Monocyte percentage, Muscular weakness, Nausea, Neutrophil count normal, Neutrophil percentage increased, Palpitations, Platelet count normal, Protein total normal, Red blood cell count normal, Red blood cell nucleated morphology, Red cell distribution width, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Acute pancreatitis (broad), Haematopoietic leukopenia (broad), Peripheral neuropathy (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hearing impairment (broad), Hypersensitivity (narrow), Myelodysplastic syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Albuterol 90 mcg/actuation 2 puffs inhaled q4h prn sob/wheezing Aspirin EC 81 mg PO Daily Bupropion SR 150 PO Daily Calcium carbonate + Vitamin D 600mg PO Daily Cinnamon Bark 2 capsules PO Daily prn Clonazepam 0.5 mg PO Daily prn anxiety Cl
Current Illness: N/A
Preexisting Conditions: Asthma Fibrocystic breast disease Hyperlipidemia Irritable bowel syndrome Insomnia Migraines Polycystic ovarian syndrome
Allergies: Latex gloves - Anaphylaxis Iodine - Swelling Shellfish - Unknown Oseltamivir - Unknown Tramadol - Itching, N/V
Diagnostic Lab Data: CT Head w/o contrast (12/31/20 @ 1813) READING: I see no evidence of hemorrhage, mass effect, abnormal attenuation, extra-axial lesions, ventriculomegaly or other suspicious intracranial pathology. Included paranasal sinuses, mastoids and middle ears are clear. Calvarium intact. IMPRESSION: no acute intracranial pathology Chest X-Ray (12/31/20 @ 1821) READING: No suspicious cardiomediastinal pathology. No infiltrates or other suspicious pulmonary or pleural pathology. I see no acute abnormality. CT Angiogram w/o contrast (12/31/20 @ 1816) READING: Both common carotid arteries and the vertebral arteries are patent and normal. Do not see any plaque or stenosis. Both carotid bifurcations are normal. The internal carotid arteries remain patent throughout the course without stenosis or occlusion in the basal artery is normal. Anterior posterior cerebral arteries widely patent without stenosis or occlusion. No arterial venous malformation or aneurysm or other vascular abnormalities. IMPRESSION: No arterial stenotic or occlusive disease of the head or neck EKC 12-Lead (12/31/20 @ 1728) Systolic Blood Pressure: 172 Diastolic Blood Pressure: 96 Vent Rate: 93 Atrial Rate: 93 PR Interval: 150 QRS Interval: 78 QT Interval: 356 QTC Interval: 442 P Axis: 66 R Axis: 25 T Axis: 22 CBC w/diff (12/31/20 @ 1845) WBC: 6.4 RBC: 5.28 Hemoglobin: 14.2 Hematocrit: 43.7 MCV: 82.8 MCH: 26.9 (L) MCHC: 32.5 RDW SD: 37.8 Platelet: 197 MPV: 11 (H) NRBC Percent: 0.0 NRBC Absolute: 0.000 Absolute Neutrophil: 4.9 Lymphocyte Absolute: 1.1 Monocytes Absolute, Automated: 0.38 Absolute Eosinophil: 0.07 Basophil Absolute: 0.05 Absolute Immature Granulocytes: 0.01 (H) Neutrophil percent: 75.2 (H) Lymphocyte percent: 16.8 (L) Monocyte percent: 5.9 Eosinophil percent: 1.1 Basophil percent: 0.8 Immature Granulocytes percent: 0.20 (H) CMP (12/31/20 @ 1845) Sodium: 138 Potassium: 3.9 Chloride: 105 CO2: 28 Anion gap: 5 (L) Glucose: 82 BUN: 19 (H) Creatinine: 0.88 BUN/Creatinine Ratio: 21.6 Calcium: 9.8 Protein total: 7.8 Albumin: 3.9 AST: 24 ALT: 23 ALP: 71 eGFR non-African American: $g60.0 eGFR African American: $g60.0 Bilirubin total: 0.8
CDC Split Type:

Write-up: Presented to the ED with cc of left sided facial and LUE numbness and weakness x 1 days. Patient received her COVID-19 vaccination on 12/30/2020 around 1PM. Immediately after the injection in her left shoulder, she began to feel warmth and numbness in her left shoulder, arm, neck, face, and chest. She reports later experiencing nausea, palpitations, and left arm weakness. Her symptoms persisted, and her family noted a left sided facial droop which prompted her ED visit. In the ED, patient was noted to have some left sided facial droop and left arm and leg weakness. CT head and CTA showed no acute abnormalities. Tele-neurology was consulted who recommended admission to rule out acute stroke. Ultimately, work up was negative and symptoms resolved. Symptoms appear to be related to the vaccine.


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