VAERS ID: 1051651

AGE: 58| SEX: M|STATE: NY (United States)

Description

Abdominal pain, nausea and vomiting, shortness of breath, acidosis, hypoglycemia, death. Onset of abdominal pain was 30 minutes after administration of the vaccine followed by 20+ episodes of vomiting and dry heaving.

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Symptoms

Vomiting, Dyspnoea, Nausea, Abdominal pain, Alanine aminotransferase increased, Blood urea increased, Aspartate aminotransferase increased, Acidosis, Cholelithiasis, Hypoglycaemia, Atelectasis, Pleural effusion, Pericardial effusion, Blood alkaline phosphatase increased, Blood creatinine increased, Ascites, Enteritis, Ileus, Proctitis, White blood cell count decreased, Retching, Platelet count decreased, Blood potassium decreased, Death, Activated partial thromboplastin time prolonged, Blood glucose decreased, Varices oesophageal, Blood pH decreased, Blood bicarbonate decreased, Troponin, Fibrin D dimer, International normalised ratio increased, Angiogram pulmonary abnormal, Blood bilirubin, Blood lactic acid, Anion gap, Computerised tomogram abdomen abnormal, Blood albumin, PCO2 increased, Bilirubin conjugated, Blood lactic acid normal, Angiogram pulmonary normal, N-terminal prohormone brain natriuretic peptide increased, Blood pH increased, Computerised tomogram pelvis abnormal, Atypical mycobacterial infection

Vaccines

VAX DATE: 02-23-2021| ONSET DATE: 02-23-2021| DAYS TO ONSET: 0
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 014m20a IM LA

RECVDATE:02-24-2021
RPT_DATE:
CAGE_YR:58
CAGE_MO:
DIED:Y
DATEDIED:02-24-2021
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:2/23/21: White count is 2.1, platelet 26, INR 1.7, PTT 107.5, D-dimer greater than 5000 pH is 7.03 with PCO2 of 50, potassium 3.3, bicarb of 16, anion gap of 21, BUN of 26, creatinine 2.5, glucose of 39, lactic acid of 14.6, total bilirubin of 4.58, direct bilirubin of 3.87, AST 134, ALT of 43, alk phos of 194. Troponin is negative. proBNP of 4229. Albumin 1.9. CT scan of the abdomen pelvis shows complex fluid attenuation the posterior right hepatic lobe, possibly metastasis, nonspecific hepatic morphology, possibly cirrhosis. Small volume ascites, punctate calcified gallstone with pericholecystic fluid related to ascites. Infiltration of the submucosal fat of the ascending colon. Possible wall thickening of a short segment of jejunum possibly infectious or inflammatory process such as enteritis. Distention of a few loops of jejunum which may represent localized ileus. Fluid within the distal thoracic esophagus which can be seen in reflux. Mild wall thickening of the GE junction with intraluminal nodularity which may represent esophageal varices. Limited evaluation of bladder due to incomplete distention with possible mucosal hyperenhancement. CT angiogram of the chest demonstrates no evidence of pulmonary thromboembolic disease. Small segmental and subsegmental pulmonary emboli cannot be excluded. Distention of the entirety of thoracic esophagus with simple fluid. Trace bilateral pleural effusions. Overlying compressive atelectasis. Small pericardial effusion. Small focal atelectasis or atypical infection in the inferior lingula.
V_ADMINBY:SCH
OTHER_MEDS:Lisinopril, metoprolol, simvastatin, acetaminophen, ibuprofen, calcium carbonate, furosemide, diphenoxylate/atropine, magnesium chloride, omeprazole, Carafate, testosterone, vitamin D3, levothyroxine
CUR_ILL:
HISTORY:Colon Cancer Hypothyroidism Hyperlipidemia GERD Hypertension
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:02-24-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:Y
ALLERGIES:NKDA
V_FUNDBY:

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