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From the 5/7/2021 release of VAERS data (an older release, current is 11/26/2021):

This is VAERS ID 937579

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Case Details

VAERS ID: 937579 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Minnesota  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-01-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Senior Living       Purchased by: ?
Symptoms: Abdominal pain, Acute respiratory distress syndrome, Arteriosclerosis coronary artery, Ascites, Atrial fibrillation, Blood culture negative, Blood lactic acid, Blood potassium decreased, Brain natriuretic peptide normal, C-reactive protein increased, Chronic obstructive pulmonary disease, Computerised tomogram abdomen abnormal, Computerised tomogram thorax abnormal, Confusional state, Culture urine positive, Diarrhoea, Dyspnoea, Electrocardiogram abnormal, Fall, Haematocrit decreased, Haemoglobin decreased, Hepatic cirrhosis, Hiatus hernia, International normalised ratio increased, Lipase normal, Lung opacity, Myalgia, Nausea, Oedema, Pancreatitis, Platelet count decreased, Portal hypertension, Procalcitonin increased, Pulmonary embolism, Pyrexia, Red blood cell count decreased, Scan with contrast, Sepsis, Sinus tachycardia, Splenic granuloma, Tachycardia, Tachypnoea, Vomiting, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Cardiac failure (broad), Liver related investigations, signs and symptoms (narrow), Hepatic failure, fibrosis and cirrhosis and other liver damage-related conditions (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (narrow), Acute pancreatitis (narrow), Angioedema (broad), Asthma/bronchospasm (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Haematopoietic thrombocytopenia (narrow), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Retroperitoneal fibrosis (broad), Dementia (broad), Pseudomembranous colitis (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Other ischaemic heart disease (narrow), Noninfectious diarrhoea (narrow), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (narrow), Hypoglycaemia (broad), Infective pneumonia (broad), Dehydration (broad), Hypokalaemia (narrow), Sepsis (narrow), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zyprexa 15 mg tablet once daily Levothyroxine 100 mcg tablet once daily Metformin ER 500 mg tablet 2 tablets by mouth twice daily Divalproex DR 240 mg Give 3 tablets by mouth once daily Metoprolol tartrate 50 mg tablet by mouth twice daily
Current Illness: COVID 19 (tested positive on 11/27/2020). Appeared to have recovered, but had some weight loss as well as persistent weakness, activity intolerance.
Preexisting Conditions: Schizophrenia Dementia without behavioral disturbance Personal history of covid-19 (Tested positive on 11/27/2020) Type 2 diabetes mellitus Morbid Obesity Essential Hypertension BPH with LUTS Allergic rhinitis Hypothyroidism Seborrheic dermatitis Fatty liver disease Pancytopenia Glaucoma History of nicotine dependence, cigarettes
Allergies: Ciclopirox- erythema and pruritus Naltrexone- reaction dizziness Topiramate- mood changes
Diagnostic Lab Data: 12/31/2020: WBC 4.8 K/uL ; RBC 4.23 M/Ul; Hgb 12.9 g/dL; Hct 38.6%; Platelets 63 k/uL; Blood culture: No growth; Urine culture: Moderate mixed flora; Lipase 55 U/L; Procalcitonin 2.38 ng/mL; BNP 90; Lactic acid 7.2 mmo/L; CRP 110.5 mg/L; Potassium 3.4 mmol/L; INR 2.4 ; CT Angio Chest: Pulmonary embolism left and right; Moderate pachy peripheral ground glass right infiltrates Heavy triple vessel coronary calcification with heavy left main coronary calcification. Mild inflammatory stranding around the normal appearing pancreatic head suggesting pancreatitis. Moderate thickening of the wall of distal esophagus associate with small hiatal hernia: EKG on 12/31/2020: Sinus tachycardia; EKG on 1/2/2021: Atrial fibrillation with rapid RVR; On 1/3/2021: CT abdomen with contrast liver cirrhosis with portal venous hypertension, multiple splenic granulomata, recanalization of the umbilical vein. Third spacing with body wall edema and mild pericholecystic ascites. The mild stranding in the upper abdominal fat could represent mild pericholecystic ascites. Mostly liquid stool throughout colon without findings of intestinal obstruction.
CDC Split Type:

Write-up: On 12/31/2020, at approximately 00:15, pt developed a fever of 102.9 F and tachycardia with rate of 120. He was treated with acetaminophen. Later in the morning, he complained of nausea, generalized muscle aches, intermittent increase in confusion. At approximately 14:00, he had a fall out of bed and at that time noted to be short of breath, tachypneic. He was taken via ambulance to Emergency Department. From there he was transferred to Hospital for admission with acute respiratory distress, suspected sepsis with lactic acid 7.4 and Bilateral Pulmonary Emboli. He was started on heparin and broad spectrum antibiotics and transitioned to ELIQUIS on 1/3/2021. Infectious etiology of sepsis was unclear. He continued broad spectrum antibiotics with clinical improvement. Abdominal CT scan was obtained due to intermittent nausea, vomiting, abdominal pain, loose stools. His heart rhythm flipped to Atrial Fibrillation with RVR on 1/2 and his rate improved with titration of metoprolol. He was also treated with prednisone for suspected underlying undiagnosed COPD. It is noted in his hospital summary that PEs presumed provoked in the setting of his recent COVID 19 infection. He was discharged from the hospital on 1/8/2021 and readmitted to the Veterans Home. He has been stable.

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