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From the 5/7/2021 release of VAERS data (an older release, current is 6/11/2021):

This is VAERS ID 1138350



Case Details

VAERS ID: 1138350 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-24
Onset:2021-03-25
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Diarrhoea, Dyspnoea, Fatigue, Hypoxia, Myalgia, Peripheral swelling, Productive cough, Pyrexia, Rheumatoid arthritis, Rheumatoid factor positive, Sputum discoloured, Urine output increased
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (narrow)

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, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness: With regard to his history,[KE.4] He was admitted 1/15-1/20/21 for an MVA with T3 burst fracture, T4 body fracture, multiple rib fractures, and cervical stenosis with bulging discs that required cervical spinal fusion with decompressive laminectomies and a reduction of T3-4.Course complicated by LUE weakness, but he was transferred to IPR and was overall able to rehab well and was discharged on 2/4/21. Following discharge, he struggled with pain control and insomnia, and was ultimately found out of bed altered on 2/22. He presented to the ED with altered mental status in the setting of hypercarbic respiratory failure and was initially managed with BiPAP and a narcan drip, ultimately thought to be multifactorial in the setting of cocaine ingestion, undiagnosed OHS/OSA, rib fractures, and aspiration pneumonia, and completed a course of zosyn and azithromycin for aspiration pneumonia. He was ultimately discharged to SAR on 3/3/21.[KE.3]
Preexisting Conditions: Bipolar disorder (CMS/HCC) ? CKD (chronic kidney disease) ? Cocaine use ? Depression ? Diabetes mellitus (CMS/HCC) ? Hyperlipidemia ? Hypertension ? Stroke (CMS/HCC) 2016 11/2016 and 05/017
Allergies:
Diagnostic Lab Data: RA positive 3/25 Abbot ID now PCR positive 3/26
CDC Split Type:

Write-up: COVID infection post vaccination 1 day following vaccination, patient experienced fatigue, myalgia and low grade fever. RA test positive. That evening, patient with increasing SOB and increasing oxygen requirement and was admitted for hypoxia + LE swelling. Although SNF where vaccination took place denied symptoms at time of vaccination, per H&P, increasing oxygen requirements were noted 3 days prior to vaccination. See H&P below He is currently residing in a rehab facility following a hospitalization detailed below, but essentially he noted some shortness of breath about 4-5 days ago. They checked his oxygen saturation and noted that he was hypoxic, so started him on oxygen (reportedly 4L NC?). He reports a worsened productive cough; sputum is dark but not bloody in color. He has been fatigued and chilled; he thinks he''s been intermittently febrile. No nausea, vomiting, or constipation. He endorses twice daily diarrhea, but he associates this with his bowel regimen. He also has a fair amount of lower extremity swelling which is bothersome to him; he says this has been ongoing since his MVA in January.[KE.4] He was recently seen in Nephrology clinic, where he was started on lasix 40mg daily and started on a low sodium diet[KE.3]. He is unsure if the lasix is helping his swelling, but does have robust urine output after he takes it


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