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From the 4/8/2021 release of VAERS data:

This is VAERS ID 983428



Case Details

VAERS ID: 983428 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Nebraska  
Vaccinated:2020-12-24
Onset:2021-01-06
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-01-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 025J20-2A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Anaemia, Aortic stenosis, Asthenia, Atelectasis, Atrioventricular block complete, Blood creatinine increased, Blood potassium decreased, Blood pressure fluctuation, Blood sodium decreased, Blood urea increased, C-reactive protein increased, Cardiomegaly, Chest X-ray abnormal, Condition aggravated, Death, Dehydration, Fatigue, Haemoglobin decreased, Hypertension, Lung infiltration, Procalcitonin increased, Sepsis, Staphylococcal bacteraemia, Vomiting, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Cardiac failure (broad), Acute pancreatitis (broad), Haematopoietic erythropenia (broad), Haemorrhage laboratory terms (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Conduction defects (narrow), 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), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hyponatraemia/SIADH (narrow), Hypertension (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Dehydration (narrow), Hypokalaemia (narrow), Sepsis (narrow), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-01-18
   Days after onset: 12
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 13 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Bystolic - started on 12/21/20, Crestor started on 11/09/2020, Qzemoic subq weekly, Advair diskus, Fish oil, ASA, Vitamin E, Multivitamin
Current Illness: Denied any illness at time of the vaccination. November 2020 was diagnosed with Covid-19. Admitted to Hospital on 01/6/2021 with c/o weakness. Reported that her weakness was over her entire body. Reports having episodes of vomiting once or twice a week.
Preexisting Conditions: Erysipelas, Aphthous pharyngitis, Sixth nerve palsy, Heart mumur, Acute renal insufficiency, Hypertension, Diabetes Mellitus
Allergies: NKA to medications
Diagnostic Lab Data: See above for further inform. 1/8/2021 WBC - 14.4, Hgb - 9.2, K+ - 2.9, BUN - 34, Creatitine -1.8, C-Reactive Protein - 12.8, Procalcitonin - 0.64, CXR - 01/07/2021 - Mild increased bibasilar atelectasis or infiltrate. No pleural effusion, no pneumothorax, stable mild cardiomegaly.
CDC Split Type:

Write-up: Pt. was admitted to hospital on 1/6/21 with fatigue, weakness. Pt. was Covid positive in November of 2020. Impression upon admission was fatigue may be due to her aortic stenosis and some hypertensive issues with blood pressure changes. She was anemic. WBC was elevated to 19.2, HBG 10.5, NA-131, K+ - 3.1, Rule out bacterial infection. Potential source could be her heart valve. Also noted to have acute renal failure with BUN of 47 and Creatinine of 2.2 noted. Pt. was transferred to Hospital on 1/8/2021 with dx of aortic stenosis, bacteremia, ARF, Dehydration and anemia. Discharged with dx. of sepsis. Pt. expired on 1/18/21 with dx. of severe sepsis, complete heart block, staphylococcus epidermidis bacteremia.


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