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

This is VAERS ID 981928



Case Details

VAERS ID: 981928 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Puerto Rico  
Vaccinated:2021-01-08
Onset:2021-01-09
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Activated partial thromboplastin time prolonged, Acute kidney injury, Alanine aminotransferase increased, Albumin globulin ratio decreased, Amylase normal, Anion gap increased, Aspartate aminotransferase increased, Basophil count increased, Basophil percentage, Blood albumin normal, Blood alkaline phosphatase increased, Blood bilirubin increased, Blood calcium decreased, Blood chloride normal, Blood cholesterol normal, Blood creatine increased, Blood creatinine increased, Blood glucose increased, Blood lactate dehydrogenase increased, Blood osmolarity increased, Blood potassium decreased, Blood smear test abnormal, Blood sodium normal, Blood urea increased, Carbon dioxide decreased, Disseminated intravascular coagulation, Eosinophil count decreased, Eosinophil percentage decreased, Gamma-glutamyltransferase increased, Globulin, Glomerular filtration rate decreased, Haematocrit decreased, Haemoglobin decreased, Hypoglycaemia, Immature granulocyte count increased, International normalised ratio increased, Lipase normal, Lymphocyte count decreased, Lymphocyte percentage decreased, Mean cell haemoglobin increased, Mean cell volume increased, Mean platelet volume normal, Mechanical ventilation, Monocyte count normal, Monocyte percentage decreased, Neutrophil count increased, Neutrophil percentage increased, Pancreatitis acute, Platelet count decreased, Pneumonia, Protein total decreased, Prothrombin time prolonged, Red blood cell count decreased, Red blood cell nucleated morphology, Red cell distribution width increased, Respiratory failure, Sepsis, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Liver related investigations, signs and symptoms (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Acute pancreatitis (narrow), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Lactic acidosis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (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, vessel type unspecified and mixed arterial and venous (narrow), Acute central respiratory depression (narrow), Biliary system related investigations, signs and symptoms (narrow), Guillain-Barre syndrome (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Hypersensitivity (broad), Tumour lysis syndrome (narrow), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (narrow), Infective pneumonia (narrow), Dehydration (broad), Hypokalaemia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Benadryl 50mg PO HS, Duloxetine 30mg POD, Folic Acid 1mg POD, Gabapentin 300mg POD, Gemfibrozil 600mg POD, methotrexate 2.5mg PO weekly, Prednisone 5mg POD, Propranolol 80mg POD, Sulfasalazine 1gm POD
Current Illness:
Preexisting Conditions: rheumatoid arthritis, fibromyalgia, essential tremors, unspecified cardiac arrhythmia, anxiety
Allergies:
Diagnostic Lab Data: White Blood Count | 21.42 | H | 3.98-10.04 10^3/uL | | RECHECKED | | Red Blood Count | 3.29 | L | 3.93-5.22 10^6/uL | Hemoglobin | 11.00 | L | 11.2-15.7 g/dL | Hematocrit | 34.10 | | 34.1-44.9 % | Mean Corpuscular Volume | 103.6 | H | 79.0-94.8 fL | Mean Corpuscular Hemoglobin | 33.4 | H | 25.6-32.2 pg | Mean Corpuscular HGB Conc | 32.3 | | 32.2-36.5 g/dL | RDW Standard Deviation | 57.3 | H | 35.1-46.3 fL | RDW Coefficient of Variation | 14.9 | H | 11.6-14.4 % | Platelet Count | 52 | L | 163-369 10^3/uL | | RECHECKED | RESULTS CALLED TO RN AT 0326 BY MT | | PLATELETS ESTIMATED BY SMEAR | 2-10 PLTS/FIELD Mean Platelet Volume | 12.1 | | 9.4-12.4 fL | Neutrophils Percent Auto | 93.2 | H | 34.0-71.1 | Lymphocytes Percent Auto | 4.1 | L | 19.3-53.1 | Monocytes Percent Auto | 1.5 | L | 4.7-12.5 % | Eosinophils Percent Auto | 0.0 | L | 0.7-7.0 % | Basophils Percent Auto | 0.5 | | 0.1-1.2 % | Immature Granulocyte | 0.7 | H | 0.0-0.4 % | Neutrophils Absolute Auto | 19.96 | H | 1.56-6.13 10^3/uL | Lymphocytes Absolute Auto | 0.88 | L | 1.18-3.74 10^3/uL | Monocytes Absolute Auto | 0.32 | | 0.24-0.82 10^3/uL | Eosinophils Absolute Auto | 0.01 | L | 0.04-0.54 10^3/uL | Basophils Absolute Auto | 0.11 | H | 0.01-0.08 10^3/uL | Immature Granulocyte Absolute | 0.14 | H | 0.00-0.03 10^3/uL | Neutrophils Percent Manual | 68 | | 44-76 % | Band Neutrophils Percent | 16 | H | 2-6 % | Lymphocytes Percent Manual | 8 | L | 15-43 % | Monocytes Percent Manual | 8 | | 2-12 | Nucleated Red Blood Cells | 0.2 | | 0.0-1.0 % | Nucleated RBC Absolute | 0.04 | | 0.0-0.10 10^3/uL | Dohle Bodies | 1+ | | | PT/PTT COMBO Prothrombin Time | 16.90 | H | 9.5-12.0 sec | INR | 1.64 | H | 0.86-1.12 | Partial Thromboplastin Time | 42.50 | H | 24.0-33.0 sec | Sodium | 136 | | 136-145 mmol/L | Potassium | 3.20 | L | 3.50-5.10 mmol/L | Chloride | 100 | | 98-107 mmol/L | Carbon Dioxide | 13.00 | L | 21.00-32.00 mmol/L | Anion Gap | 23.00 | H | 10-20 | Blood Urea Nitrogen | 66.00 | H | 7.00-18.00 mg/dL | Creatinine | 4.53 | H | 0.6-1.30 mg/dL | Estimated Glomerular Filt Rate | 10.2 | | | | Reference Values: Greater than 60.0 mL/min/1.73 sqm. | Please multiply de GFR result by 1.210 in case of patients | who are African American. The IDMS-Traceable MDRD Study | Equation is applied to patients who are 18 year or older. | The MDRD Study equation has not been tested in children, the | elderly (over 70 years of age), pregnant women, patients | with serious comorbid conditions, or person with extremes of | body size, muscle mass or nutritional status. BUN Creatinine Ratio | 14.6 | | 12.0-20.0 mg/dL | Pharmacy Creatinine | 16.389 | | | Glucose | 221 | H | 74-106 mg/dL | Osmolality Calculated| 298.10 | H | 275.00-295.00 mmol/L | Calcium | 8.1 | L | 8.5-10.1 mg/dL | Total Bilirubin | 1.10 | H | 0.2-1.0 mg/dL | Direct Bilirubin | 0.80 | H | 0.0-0.3 mg/dL | Indirect Bilirubin | 0.30 | | 0.20-1.20 mg/dL | Gamma Glutamyl Transpeptidase | 86 | H | 5-55 U/L | Aspartate Amino Transferase | 121 | H | 15-37 U/L | Alanine Aminotransferase | 43 | | 12-78 U/L | Lactate Dehydrogenase| 672 | H | 84-246 U/L | Total Protein | 6.2 | L | 6.4-8.2 g/dL | Albumin | 3.6 | | 3.4-5.0 g/dL | Globulin | 2.6 | | 2.3-3.5 g/dL | Albumin Globulin Ratio | 1.38 | L | 1.50-2.2 g/dL | Cholesterol | 96 | | 0-240 mg/dL | | Reference Ranges: | | 2-17 years | Desirable: <170 mg/dL | Borderline High: 170-199 mg/dL | High: $g=200 mg/dL | | 18 years or Older | Desirable: <200 mg/dL | Bordeline High: 200-239 mg/dL | High: $g=240 mg/dL Alkaline Phosphatase | 241 | H | 42-117 U/L | Amylase | 74.00 | | 25.00-115.00 U/L | Lipase | 32 | | 12-53 U/L | | New reference range for Atellica Method.
CDC Split Type:

Write-up: Sepsis, Acute Pancreatitis, Respiratory Failure on Mechanical Ventilation, Disseminated Intravascular Coagulation, Pneumonia, Acute Kidney Injury. Refractory Hypoglycemia


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