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From the 3/11/2021 release of VAERS data (an older release, current is 11/19/2021):

This is VAERS ID 1080435

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Case Details

VAERS ID: 1080435 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-02-27
Onset:2021-03-01
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6198 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Death
SMQs:

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-03-01
   Days after onset: 0
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: ALL LABS WITHIN 30 DAYS PRIOR TO DEATH----CHEMISTRY -GENERAL----SERUM Feb 26 Feb 09 Feb 09 Reference 2021 2021 2021 08:45 11:20 11:29 Units Ranges NA 142 136 mmol/L 135 - 145 K 4.1 5.1 H mmol/L 3.5 - 5 CL 106 94 L mmol/L 100 - 110 CO2 26 30 mmol/L 20 -30 BUN 21 39 H mg/dL 7 - 25 CREAT 1.7 H 3.7 H mg/dL .5 - 1.5 cGFR 50 L 20L* mL/min Ref: $g=60 GLUCOSE 106H 116 H mg/dL 65 - 100 CA,TOT 8.6 9.0 mg/dL 8.5-10.5 PROTEIN 7.3 7.5 g/dL 6 - 8.5 ALBUMIN 3.7 3.6 g/dL 3.5 - 5 PO4 3.7 3.1 mg/dL 2.5 - 5 URIC AC 10.9 H mg/dL 3.3 - 8.7 T. BIL 0.30 0.40 mg/dL .2 - 1.2 D. BILI 0.1 0.2 mg/dL 0 - .5 LD TOT U/L 125 - 243 TRYGLYC 168 mg/dL 0 - 199 CHOL 192 mg/dL 0 - 199 HDL 59 mg/dL Ref: $g=40 VLDL mg/dL 0 - 30 LDL 99 mg/dL 0 - 129 D.LDL mg/dL 0 - 129 AST 15 16 U/L 5 - 40 ALT 11 17 U/L 7 - 52 ALK PHO 63 59 U/L 40 - 150 CK TOT U/L 30 - 200 AMYLASE 129 H U/L 25 - 125 LIPASE 89 H U/L 8 - 70 MAG 1.9 1.7 mg/dL 1.6 - 2.6 GGT U/L 10 - 65 TOT AcP U/L 3.1 - 7 ProsAcP ng/mL 0 - 2.7 COPPER 5''NUC U/L 0 - 10 CERULOP mg/dL 20 - 60 OSMOL mOsm/kg 275 - 300 ANION G 10 12 mEq/L 6 - 16 COMMENTS: a d h a. Evaluation for GLU: Results must be interpreted on a case-by case basis. Values $g200 may require further follow-up to rule out diabetic mellitus. ***For test CO2 Units: mEq/L *** Evaluation for MG: Minor changes to reference range were implemented on 6/13/12 in order to standardize ranges across the database. *** For test cGFR Normals: low: $g=60 *** Evaluation for cGFR: As of April 16, 2010 a new formula was implemented for cGFR which is based on a creatinine that is now matched to the national standard (IDMS). New values should be considered more accurate. Ordering Provider: MD Report Released..: Feb 26, 2021@10:40 Reporting Lab.....Effective 10/16/13 - Vitamin D, Total (Screen) test should not be used when single dose 50,000 IU D2 is administered. *** For test CO2 Units: mEqL *** Evaluation for UA: Patients receiving Elitck(Rasburicase) therapy may have falsely decreased uric acid values if drawn in a room temperature gold top tube(scrum). If concerned about Rasburicase interference, please recollect blood sample in a pre-chilled green top tube containing heparin, immediately place on ice and deliver ASAP for analysis. Evaluation for CHO: <200 mg/dL is desirable; 200-239 is borderline/high; $g=240 is high Evaluation for TRI: 150-199 mg/dL is Borderline-high 200-499 is High 500 mg/dL or above is Very High*** For test HDL Normals: low: $g=40 *** *** For test cGFR Normals: low: $g=60 *** Ordering Provider: MD Report Released..: Feb 09, 2021@13:13 Reporting Lab....: Performing Lab...: *CHEM 7 Not Performed: Feb 09, 2021@11:33 *NP Reason: duplicate *LIPASE Not Performed: Feb 09, 2021@11:33 *NP Reason: duplicate Ordering Provider: MD Report Released..: Feb 09, 2021@12:32 Reporting Lab....: Performing Lab...: ENDOCRINE TESTS,SERUM ----SERUM TSH T-4 T%UPTK FTI T4 FRE T3 FRE E E Ref range low .35 4.5 32 5.9 .6 70 2.3 Ref range high 5 12 48 13.1 1.6 180 4.2 uIU/mL ug/dL % uptake ng/dL ng/dL pg/mL [d] Feb 09, 2021 11:30 0.78 SERUM REV T-T4 BIN PTH IN LH FSH PROLAC 3 D T T Ref range low 12.7 10 1 1 Ref range high 25.1 65 9 19 mcg/mL pg/mL mIU/mL mIU/mL ng/mL SERUM GROWTH CORTIS ALDOST ANGIO- TESTOS L E 1 Ref range low 3 9 1.53 Ref range high 16 67 8.92 ug/dL U/L ng/mL SERUM SHBG DHEA-S ESTRAD PROGES B-OHB TESTO, L T TOTAL Ref range low .02 220 Ref range high .27 892 mmol/L ng/dL SERUM LYSOZY PTH(QUEST CAROTE 25 OH GASTRI PTH pr M) N D N o Ref range low 4 20 Ref range high 51 50 mcg/dL ng/mL [d] Feb 09, 2021 11:30 26.0 SERUM PTH,MM PTH IN (Y) T d. Effective 10/16/13 - Vitamin D, Total (Screen) test should not be used when single dose 50,000 IU D2 is administered. *** For test TSH Units: mIU/mL *** Evaluation for TSH: As of Sept.27, 2011, new instrumentation is being used for TSH. Note change in reference range. Evaluation for VIT D: As of May 16, 2012, this test replaces Vit D 25-OH Panel. Results with new assay are comparable to old assay. Unexpectedly high values in patients receiving supplementation may be falsely elevated, and can be confirmed with 25-OH VITAMIN D2/3 (Rx Monitor) test if clinically indicated. Note also reference range change to reflect Institute of Medicine recommendations. See below for Scrum (25 OH) Vitamin D Concentrations vs. Health Status: Vitamin D (ng/mL): Health Status: <12 Associated with Vitamin D deficiency, leading to rickets in infants and osteomalacia in adults. 12-20 Generally considered inadequate for both bone and overall health in healthy individuals. $g=20 Generally considered adequate for bone and overall health in healthy individuals. $g50 Emerging evidence links potential adverse effects to such levels particularly $g60 ng/mL. Ordering Provider: MD Released..: Feb 09, 2021@13:13 Reporting Lab....: Performing Lab...: HEMATOLOGY ----BLOOD Feb 26 Feb 09 Reference 2021 2021 08:45 11:29 Units Ranges---WBC 4.8 8.3 K/cmm4.5 - 11 HCT 34.7 L 36.0 L % 39.2 - 50.4 HGB 11.1 L 11.8 L g/dL 12.8 - 17 RBC 3.53 L 3.69 L M/cmm 4.23 - 5.66 MCV 98.3 97.6 fL 82 - 99 MCH 31.4 32.0 pg 26.2 - 32.6 MCHC 32.0 32.8 g/dL 30.8 - 35.1 RDW 12.7 11.9 L % 12 - 16 RETIC % .8 - 2 RETIC # K/cmm 30 - 90 RET-Hc pg ATY MON % PLT 264 239 K/cmm 140 - 360 MPV 10.5 10.3 fL 9.2 - 12.4 IPF % 1 - 7 IG % 0.2 0.6 % 0 - .7 nRBC 0.0 0.0 %/WBC 0 - 0 Gran 61.8 70.9 % 43.7 - 75.8 Lymph 24.7 16.8 % 14 - 42.3 Mono 10.6 10.1 % 5.1 - 13.7 Eosin 2.1 1.4 % .4 - 6.8 Baso 0.6 0.2 % .1 - 2 AtLym % 0 - 6 Meta % 0 - 1 Myclo % 0 - 0 Promy % 0 - 0 Blast % 0 - 0 MORPH: Ansio Poilkil Ovalo Acanth Teardp Target Polych Hypoch Bastip ToxGrn Schist Sphero ABS NEU 2.97 5.88 K/cmm 2.2 - 7.6 ABS LYM 1.19 1.40 K/cmm 1 - 3.2 PLT.EST Comments: c i c. Ordering Provider: MD Report Released..: Feb 26, 2021@09:56 Reporting Lab....: Performing Lab...: Smear made available for clinician review or clinical pathology E-consult. Ordering Provider: MD Report Released..: Feb 09, 2021@12:25 Reporting Lab....: Performing Lab...: SEDIMENTATION RATE ---- BLOOD SEDRATE ESR(WHAV) Ref range low 0 0 Ref range high 30 30 mm/hr mm/hr [c] Feb 26, 2021 08:45 80H [i] Feb 09, 2021 11:29 95 H c. Evaluation for ESR: Starting January 2016, the Hematology Laboratory will implement a new technology for the measurement of Erythrocyte Sedimentation Rates (ESR). The Laboratory will implement this change beginning July 2017. This new methodology will reduce the sample size required and improve turnaround times. The new platform, is manufactured and distributed by Agency. Normal ranges will not change, though some patient will need to have new baselines established due to increased sensitivity of the test and the fact that this technology may not be affected by low hemoglobin/hematocrit levels as the other methodologies and thus is less likely to cause false elevations in the ESR. Ordering Provider: MD Report Released..: Feb 26, 2021@09:56 Reporting Lab....: Performing Lab...: Smear made available for clinician review or clinical pathology E-consult. Ordering Provider: MD Report Released..: Feb 09, 2021@12:25 Reporting Lab....: Performing Lab...: A1C HEMOGLOBIN ----BLOOD A1C cAG % mg/dL [c] Feb 09, 2021 11:30 5.8 H 120 c. 5.7 - 6.4% Prediabetes .=6.5% Diabetic range. If the patient has not yet been diagnosed with T2DM, see Clinical Practice Guideline for Management of T2DM (dated 4/2017) for more guidance. For patients already diagnosed with T2DM, target HbA1c values should be individualized using a Shared Decision-Making process. *** For test A1C Normals: low: <=5.6 *** Ordering Provider: MD Report Released..: Feb 09, 2021@12:25 Reporting Lab..... Performing Lab...: ANEMIA TESTS-SERUM --- SERUM VIT B12 FOLATE FE TIBC FE SAT Ref range low 200 5.2 40 204 20 Ref range high 900 160 475 50 pg/mL ng/mL ug/dL % [a] Feb 26, 2021 08:45 78 389 [d] Feb 09, 2021 11:30 360 .20.0 70 363 SERUM FERRITN EP TRANSFN Ref range low 20 200 Ref range high 300 360 ng/mL mg/dL [a] Feb 26, 2021 08:45 5 L [d] Feb 09, 2021 11:30 19 L a. Evaluation for FER: Male Reference Range = 20-300 Female Reference Range = 10-200 As of Septt.27, 2011, new instrumentation is being used for FERRITIN. Not change in reference range. Ordering Provider: MD Report Released..: Feb 26, 2021@10:40 Reporting Lab....: Performing Lab...: Effective 10/16/13 - Vitamin D, Total (Screen) test should not be used when single dose 50,000 IU D2 is administered. Evaluation for VIT B12: Minor changes to reference range were implemented on 6/13/12 in order to standardize ranges across the database. Levels above 300 or 400 pg/mL are rarely associated with B12 deficiency induced hematological or neurological disease, respectively. Further testing is suggested for SYMPTOMATIC patients with B12 levels between 100 and 300 pg/mL (hematological abnormalities) and between 100 and 400 pg/mL (neurological abnormalities). *** For test FOLATE Normals: low: $g=5.2 *** Evaluation for FOLATE: Minor changes to reference range were implemented on 6/13/12 in order to standardize ranges across the database. Ordering Provider: MD Report Released..: Feb 09, 2021@13:13 Reporting Lab....: Performing Lab...: TUMOR MARKERS ---- SERUM Feb 09 Reference 2021 11:30 Units Ranges--- AFP ng/mL 0 - 10 CEA ng/mL 0 - 5 PSA 0.24 ng/mL 0 - 4 CA125 CA15-3 CA19-9 CA27.29 Comments: d d. Effective 10/16/13 - Vitamin D, Total (Screen) test should not be used when single dose 50,000 IU D2 administered. Ordering Provider: MD Report Released..: Feb 09, 2021@13:13 Reporting Lab....: Performing Lab...: SERUM PROTEIN ELECTROPHORESIS & IFE ---- SERUM PROTEIN ALBUMIN ALPHA-1 ALPHA-2 BETA Ref range low 6 3.13 .19 .46 .56 Ref range high 8.5 5.37 .5 1.2 1.18 g/dL g/dL g/dL g/dL g/dL [f] Feb 09, 2021 11:29 7.4 3.81 0.32 0.95 0.84 SERUM GAMM G M-P M-P% M-P G A/G Ref range low .67 .99 Ref range high 1.67 1.81 g/dL % g/dL [f] Feb 09, 2021 11:29 1.48 1.06 SERUM IFE [g] Feb 09, 2021 11:29 comment f. SER ESSENTIALLY NORMAL SERUM PROTEIN ELECTROPHORESIS. NO PARAPROTEIN BANDS SEEN ON SPEP. SPEP reviewed by MD Ordering Provider: MD Report Released..: Feb 11, 2021@08:44 Reporting Lab....: Performing Lab...: Small M spike IgM lambda observed. Request further SPEP for measurements IEP=IMMUNOELECTROPHORESIS; IFE=IMMUNOFIXATON ELECTROPHORESIS Ordering Provider: MD Report Released..: Feb 11, 2021@08:45 Reporting Lab....: Performing Lab...: SARS-CoV-2 ANTIBODY TESTING ---- SERUM SARS-C SARS-C OV-2 oV-2 I gG Qnt gG Qua 1 Ref range low 0 Negative Ref range high 1.3 Index [b] Feb 26, 2021 08:45 0.0 Negative b. The Abbott SARS-CoV-2 IgG assay has been authorized by the FDA under an Emergency Use Authorization for use by authorized laboratories. It has not been FDA cleared or approved. Results from antibody testing should not be used as the sole basis to diagnose or exclude SARS-CoV-2 infection. Serological testing should not be used at this determine whether an individual has protective immunity or remains contagious. Test results must be considered in the context of other available clinical and laboratory findings. Negative results do not rule out SARS-COV-2 infection, particularly in those who have been in contact with the virus. Follow-up testing with a molecular diagnostic should be considered to rule out infection in these individuals. Negative results may occur in scrum collected too soon following infection, in immune suppressed patients, or in some individuals with prior mild illness. Ordering Provider: MD Report Released..: Feb 26, 2021@13:08 Reporting Lab....: Performing Lab....: MISCELLANEOUS TESTS ---- DATE TIME SPECIMEN TEST VALUE Ref ranges Feb 26, 2021@08:45 SERUM CRP,INFLAMMATION: 2.3 mg/L 0.0 - 7.9 Feb 26, 2021@08:45 SERUM TRANSFERRIN: 311 mg/dL 173 - 382 Feb 26, 2021@08:45 SERUM TRANSFERRIN SAT%:20% 15 - 45 Evaluation for CRP,INF: As of Nov 3, 2011 CRP is being performed at facility. Note change in UNITS. Numerical results are considered comparable to old method. Reference range is unchanged. Ordering Provider: MD Report Released..: Feb 26, 2021@10:40 Reporting Lab....: Performing Lab...: Feb 09, 2021@12:50 URINE: *IMMUNOFIXATION,URINE Not Performed: Feb 09, 2021@12:50 *NP Reason: see nb/wr 21 256 upep Ordering Provider: MD Reporting Lab....: Feb 09, 2021@12:11 URINE PROTEIN URINE,SPOT(WRX):<6.8 mg/dL Ref: NOT ESTABLISHED Feb 09, 2021@12:11 URINE UPEP INTERP,SPOT(WRX): No Abnormal protein present protein < 6.8 mg/dL Ordering Provider MD Report Released...: Feb 16, 2021@08:38 Reporting Lab....: Performing Lab...: Feb 09, 2021@11:30 SERUM TRANSFERRIN: 290 mg/dl 17 - 382 Feb 09, 2021@11:30 SERUM TRANSFERRING SAT%: 19 % 15 - 45 Effective 10/16/13 - Vitamin D, Total (Screen) test should not be used when single dose 50,000 IU D2 administered. Ordering Provider: MD Report Released..: Feb 09, 2021@13:13 Reporting Lab....: Performing Lab...: Feb 09, 2021@11:30 BLOOD : *CBC W/ AUTO DIFF Not Performed: Feb 09, 2021@11:52 *NP Reason: duplicate Ordering Provider: MD Reporting Lab....: FREE K/L LC RATIO: 1.94 H 0.26 - 1.65 Feb 09, 2021@11:29 SERUM KAPPA LC FREE SERUM 68.55 H mg/L 3.30 - 22.50 Feb 09, 2021@11:29 SERUM LAMBDA LC FREE SERUM: 35.39 H mg/L 5.71 - 30.50 Small M spike IgM lambda observed. Request further SPEP for measurements IEP=IMMUNOELECTROPHORESIS; IFE= IMMUNOFIXATION ELECTROPHORESIS Ordering Provider: MD Report Released..: Feb 11, 2021@08:45 Reporting Lab....: Performing Lab...: Feb 09, 2021@11:29 SERUM CRP,INFLAMMATION: 8.1 Hmg/L 0.0 - 7.9 *CHEM 7 Not performed: Feb 09, 2021@11:33 *NP Reason: duplicate *LIPASE Not Performed: Feb 09, 2021@11:33 *NP Reason: duplicate Evaluation for CRP,INF: As of Nov 3, 2011 CRP is being performed. Note change in UNITS. Numerical results are considered comparable to old method. Reference range is unchanged. Ordering Provider: MD Report Released..: Feb 09, 2021@12:32 Reporting Lab....: Performing Lab....: Feb 09, 2021@12:25 Reporting Lab....: Performing Lab...: ----BLOOD BANK ---- No ABO/Rh results. ANTIBIODIES IDENTIFIED: No Antibody results. TRANSFUSION REQUIREMENTS No Transfusion Requirements. TRANSFUSION REACTIONS: No Transfusion Reactions. AVAILABLE/ISSUED UNITS: No Available/Issued Units. DIAGNOSTIC TESTS No results. COMPONENT REQUESTS: No Component Requests. TRANSFUSED UNITS No Transfused Units.
CDC Split Type:

Write-up: DEATH Narrative: 61 y.o. male with pmh afib, substance dependance, renal failure, recent admissions in the community for acute hypotension and acute kidney injury (11/2020 & 2/2021). Was found deceased in his apartment on the afternoon of 03/01/2021. Request sent to ME office for report if one exists. Patient was listed as having no known allergies.


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