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

This is VAERS ID 951799

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Case Details

VAERS ID: 951799 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Missouri  
Vaccinated:2020-12-29
Onset:2021-01-01
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Acute myocardial infarction, Angiogram cerebral, Arteriogram carotid, Back pain, Blood gases, COVID-19 pneumonia, Catheterisation cardiac, Chest X-ray, Chest pain, Computerised tomogram thorax, Critical illness, Depressed level of consciousness, Dyspnoea, Echocardiogram, Electrocardiogram, Endotracheal intubation, Flank pain, Full blood count, Gait disturbance, Guillain-Barre syndrome, Immunoglobulin therapy, Lumbar puncture, Mechanical ventilation, Metabolic function test, Muscular weakness, Nausea, Pain, Respiratory failure, SARS-CoV-2 test positive, Stress cardiomyopathy, Troponin, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Angioedema (broad), Peripheral neuropathy (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Embolic and thrombotic events, arterial (narrow), Parkinson-like events (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (narrow), Demyelination (narrow), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypersensitivity (broad), Respiratory failure (narrow), Hypoglycaemia (broad), Infective pneumonia (narrow), Hypokalaemia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: atorvastatin (LIPITOR) 10 MG tablet glipiZIDE (GLUCOTROL XL) 10 MG 24 hr tablet losartan (COZAAR) 25 MG tablet metformin (GLUCOPHAGE) 1000 mg tablet pantoprazole (PROTONIX) 40 mg tablets
Current Illness:
Preexisting Conditions: ? Diabetes mellitus ? Hyperlipidemia ? Hypertension ? Sleep apnea
Allergies: Phenergan Dm
Diagnostic Lab Data: Lumbar puncture 1/15/21 CT Angio Chest: 1/13/2021 CT Angio Head and Neck: 1/15/21 Chest X-ray: 1/15/21 Echocardiogram: 1/13/21 and 1/16/21 ECG: 1/13/21 and 1/16/21 Cardiac catheterization:1/16/21 Blood gases, CBC, Comprehensive metabolic panel, troponin
CDC Split Type:

Write-up: The patient received her first Moderna COVID-19 vaccination on 12/29/2020. However the patient was diagnosed with a positive COVID-19 test on January 4, 2021. Patient complained of nausea, vomiting, back pain, and sharp chest pain. On January 13, the patient presented to the emergency department again with shortness of breath and sharp, stabbing left-sided chest pain radiating to her back and right side. Initial work up ruled out cardiac etiologies. CTA chest demonstrated COVID-19 pneumonia. The patient complained of bilateral lower extremity weakness which had been progressing since her COVID-19 vaccination, per patient report. However, during her hospitalization the patient''s bilateral lower extremity weakness began to accelerate. On the 13th, the patient was able to ambulate to and from the bathroom herself. Then on January 14 the patient required maximum assistance. Neurology was consulted and work up initiated for suspected possible Guillain-Barr? syndrome (GBS) secondary to recent COVID-19 infection. On January 15, 2021, the patient became obtunded and unable to protect airway. She was emergently intubated for acute hypercapnic respiratory failure secondary to GBS. Neurology started GBS treatment with IVIG. Patient also developed NSTEMI and Takotsubo cardiomyopathy. Patient remains critically ill requiring mechanical ventilation.


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