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

This is VAERS ID 946978

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Case Details

VAERS ID: 946978 (history)  
Form: Version 2.0  
Age: 49.0  
Sex: Male  
Location: Florida  
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-01-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Asthenia, Chest X-ray normal, Computerised tomogram thorax abnormal, Cough, Deep vein thrombosis, Dyspnoea, Dyspnoea exertional, Fatigue, Fibrin D dimer increased, Heart rate increased, Intensive care, Oxygen saturation decreased, Pneumonia, Pulmonary embolism, Respiratory distress, SARS-CoV-2 test negative, Thrombolysis, Ultrasound Doppler abnormal
SMQs:, Anaphylactic reaction (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Dehydration (broad), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: lexothyroxine, vitamin D, montelukast, manesium citrate
Current Illness: Sinus infection at the beginning of December treated with augmentin
Preexisting Conditions: hypothyroidism, allergic rhinitis
Allergies: NKDA
Diagnostic Lab Data: PCR covid test 1/4/21 negative Chest Xray 1/6/21 negative at the ER at the Medical Center on 1/10/21 d-dimer levels were very high, chest CT showed multiple bilateral pulmonary emboli, leg US revealed bilateral emboli
CDC Split Type:

Write-up: Onset of shortness of breath and cough on 1/3 that progressively got worse. Clinical diagnosis of pneumonia without fever was made, patient started azithromycin on 1/5 and albuterol treatments every 4-6 hrs. Initially he improved, but then worsened. chest xray on 1/6 was negative for pneumonia, PCR covid test was negative, albuterol treatment did not bring much relief. He started respiratory distress on 1/10 and was taken by car to the local ER where another covid test was negative and chest CT revealed multiple bilateral pulmonary emboli. The leg US revealed blood clots in both of his legs. He had an emergency catheter-delivered thrombolysis and was discharged home from the ICU on 1/12 on oral anticoagulants. He is gradually improving, but very weak. He tires easily and gets a drop in oxygen to 90- 93%, as well as an increase in the heart rate to 120 when walking less than half a mile. He runs out of breath with exertion.

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