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This is VAERS ID 985814

History of Changes from the VAERS Wayback Machine

First Appeared on 2/4/2021

VAERS ID: 985814
VAERS Form:2
Age:94.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-20
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-01-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Aspiration, Asthenia, Blood creatinine increased, Blood glucose normal, Blood potassium increased, Blood urea increased, Chest X-ray abnormal, Cough, Dyspnoea, Emphysema, Fatigue, Haematocrit decreased, Haemoglobin decreased, Lung consolidation, Nausea, Pulmonary granuloma, Red blood cell count decreased, Vomiting, White blood cell count decreased, Ejection fraction decreased, Respiratory tract congestion, Pulmonary mass, Computerised tomogram thorax abnormal, Pulmonary hilum mass, Echocardiogram abnormal, Left atrial dilatation, Endotracheal intubation, Oropharyngeal pain, Lung opacity, SARS-CoV-2 test negative

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-26
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: acetaminophen 500 mg amoxicillin 1 gm aspirin furosemids 40 mg glucosamine-chondroitin 1 tab cozaar 25 mg multivitamin potassium chloride 20 meq tamsulosin 0.4 mg furosemide 40 mg zofran 4 mg
Current Illness: started with a sore throat the day before vaccination
Preexisting Conditions: anemia, BPH with obstruction, cervical neuritis, cervical spondylosis, cervicalgia, enlarged prostate, HLD, HTN, left sciatic nerve pain, low back pain, lumbar spinal stenosis, osteoarthritis, pacemaker, pancytopenia
Allergies: morphine, oxycodone, hydrocodone, hydromorphone, coumadin
Diagnostic Lab Data: 1/25/21 had CBC which showed WBC at 0.1, RBC 2.52, Hgb 8.8, Hct 27.2, Chem profile done showed high potassium, high glucose of 129, elevated BUN and Creatinine. Was negative for SARS-CoV 2 on 1/25/21. CXR showed right perihilar masslike opacity which may reflect infiltrate or neoplasm. Did CT of the chest which showed bilateral upper lobe chronic emphysematous lung changes, dense right upper lobe airspace disease, left lower lobe bronchial filling defects suggesting aspiration, scattered bilateral upper lobe nodular densities, scattered left lower lobe calcified granulomas, and left hilar calcified granuloma
CDC 'Split Type':

Write-up: started having generalized weakness on 1/21/21, fatigued., nausea/vomiting. went to doctor on 1/25/21 with complaint of sore throat, cough, and felt congested. Went to ER on 1/25/21 with complaints of increased shortness of breath, worsening nausea and vomiting. started on oxygen for sats of 87%. admitted on 1/25/21. On 1/26/21 needed intubated, CXR showed worsening consolidative change right lung at right hilar level. Echocardiogram showed ejection fraction 35-40%, left atrium is moderately dilated.

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