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From the 10/15/2021 release of VAERS data:

This is VAERS ID 952872



Case Details

VAERS ID: 952872 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-01-04
Onset:2021-01-11
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-01-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL0140 / 1 UN / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Alveolar lung disease, Aortic arteriosclerosis, Aortic valve incompetence, Atelectasis, Cardiac failure, Cardiomegaly, Chest X-ray abnormal, Computerised tomogram thorax abnormal, Deep vein thrombosis, Dizziness, Echocardiogram abnormal, Fluid overload, Hypoxia, Left ventricular hypertrophy, Lung consolidation, Myocardial strain, Pleural effusion, Pulmonary embolism, Pulmonary hypertension, Right atrial dilatation, Right ventricular dysfunction, Right ventricular hypertrophy, Right ventricular systolic pressure decreased, SARS-CoV-2 test negative, Tricuspid valve incompetence, Ultrasound Doppler abnormal
SMQs:, Cardiac failure (narrow), Asthma/bronchospasm (broad), Interstitial lung disease (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (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 (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Chronic kidney disease (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin 81mg daily Vitamin B-1 100mg daily Escitalopram 20mg daily gabapentin 100mg daily Levetiracetam 1000mg BID and 500mg qhs Pantoprazole 20mg daily Phenytoin 250mg qhs rosuvastatin 20mg daily Tamsulosin 0.4mg daily MVI daily Vitamin
Current Illness: pneumonia treated with vantin (1/10)
Preexisting Conditions: hx of HTN, epilepsy, CKD, cerebral AVM s/p repair, CAD, CVA (left sided hemiplegia), ischemic heart disease s/p CABG
Allergies: nsaids -patient reports contribute to seizures
Diagnostic Lab Data: Xray Chest Single View Result Date: 1/11/2021 IMPRESSION: Cardiomegaly with borderline pulmonary vascularity. Persistent left lower lobe consolidation associated with a small left-sided pleural effusion. Minimal right basilar subsegmental atelectasis is present. Ct Chest (pe Protocol) Result Date: 1/11/2021 IMPRESSION: 1. Large bilateral pulmonary artery emboli in the right and left main pulmonary artery extending into the right and left main pulmonary artery branches bilaterally. Findings are associated with right-sided heart strain. 2. Patchy alveolar airspace disease within the lungs highly suspicious for COVID pneumonia. 3. Reflux of contrast into the inferior vena cava as well as the hepatic veins which can be seen in the setting of right-sided cardiac insufficiency. Echo 1/12/21 Conclusions: 1. Normal LV ejection fraction of 66 %. 2. Septal motion is right ventricular volume overload. 3. Borderline concentric left ventricular hypertrophy. 4. The left ventricular cavity size is decreased. 5. Mild aortic insufficiency. 6. Moderate calcification in the aorta. 7. Severely enlarged right ventricle. 8. Severely reduced RV systolic function. 9. The right atrial area is mildly dilated. 10. Mild tricuspid valve regurgitation. 11. Left atrial pressure is normal. 12. The left atrial volume index is normal at 18 ml/m??. 13. Moderate PHTN with PA systolic pressure estimated at 49 mmHg. 14. Compare to prior study, RV is larger, RV systolic function is worse, LV is smaller. LE doppler 1/12/21: FINDINGS: Right Lower Extremity: Acute occlusive vein thrombosis of the entire course of the gastrocnemius vein and soleal vein. Incompressible entire course of the gastrocnemius vein and soleal vein. Fully compressible entire course of the femoral vein, common femoral vein, deep femoral vein, popliteal vein, posterior tibial vein, peroneal vein, saphenofemoral junction, saphenopopliteal junction, great saphenous vein and small saphenous vein. Left Lower Extremity: The left common femoral, femoral, profunda femoris, popliteal and calf veins were examined. The veins are easily compressible and appear normal. There is normal spontaneous and phasic flow. The left great saphenous and small saphenous veins also appear normal. IMPRESSION: 1. Right: Acute occlusive vein thrombosis of the entire gastrocnemius vein and soleal vein. 2. No acute deep vein thrombosis or superficial vein thrombosis seen in the left leg.
CDC Split Type:

Write-up: 80YO male who htn, cva, epilepsy, ckd, cerebral avm s/p repair, cad s/p cab, cva (left sided hemiplegia) , hx of prostate cancer recent admission for pna on abx presents to ED on 1/11 with dizziness, hypoxia. CT with Bilateral PE "Large bilateral pulmonary artery emboli in the right and left main pulmonary artery extending into the right and left main pulmonary artery branches bilaterally. Findings are associated with right-sided heart strain." "Patchy alveolar airspace disease within the lungs highly suspicious for COVID pneumonia" Covid negative. Patients wife recovered from Covid-19 infection within last month. Patent thus far has tested negative. Doppler lower extremity revealed Acute occlusive vein thrombosis of the entire course of the gastrocnemius vein and soleal vein. Patient received covid vaccine on 1/4/21. Patient has several risk factors for clot - age, previous CVA, hx of prostate cancer. Also had positive covid exposure though tested negative


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