Adverse Event Reporting

VAERS ID 2548825
Gender Female
Age 65
StateCode MI
Pharmaceutical Company MODERNA
Lot Number AS7163B
Number of vaccinations 4
Vaccinated 2022-10-28
Onset 2022-12-17
Condition Hospitalized Recovered
Symptoms
  • Diarrhoea
  • Intensive care
  • Hypotension
  • Chest X-ray abnormal
  • Mental status changes
  • Blood urea increased
  • Laboratory test abnormal
  • Hypothermia
  • SARS-CoV-2 test positive
  • Computerised tomogram head normal
  • Blood lactic acid increased
  • Influenza
  • Computerised tomogram abdomen
  • Blood glucose
  • White blood cell count increased
  • COVID-19
  • Haemoglobin decreased
  • Anaemia
  • Pneumonia
  • Endotracheal intubation
  • Acute kidney injury
  • Haemodialysis
  • Blood creatinine
  • Agitation
  • Hypophagia
  • Angiogram abnormal
  • Colitis
  • Leukocytosis
  • Shock
  • Lung infiltration
  • Computerised tomogram spine
  • Glycosylated haemoglobin normal
  • Blood pH decreased
  • Renal impairment
  • Influenza A virus test positive
  • Colonoscopy
  • Acidosis
  • Extubation
  • Vascular test normal
  • Vascular catheterisation
  • Haemofiltration
  • Catheter removal
  • Red blood cell transfusion

Current Illness

Preexisting Conditions

Acute respiratory failure with hypoxia and hypercapnia (HCC) Influenza A Septic shock (HCC) Acute encephalopathy AKI (acute kidney injury) (HCC) Type 2 diabetes mellitus, without long-term current use of insulin (HCC)

Other Medications

multivitamin with mineral (THERA M PLUS) tablet Omega-3 Fatty Acids (FISH OIL) 1000 MG capsule semaglutide (OZEMPIC, 0.25 OR 0.5 MG/DOSE,) 2 MG/1.5ML pen-injector simvastatin (ZOCOR) 40 MG tablet

Previous Vaccinations

Allergies

Benadryl [Diphenhydramine] Eggs Ibuprofen Triprolidine Banana Celecoxib Penicillins Pseudoephedrine

Laboratory Data

Write-up

Discharge Provider: DO Primary Care Provider at Discharge: NP Admission Date: 12/17/2022 Discharge Date: 12/31/2022 COVID positive date: 12/17/2022 HOSPITAL COURSE: Patient is a 65-year-old female with history of type 2 diabetes mellitus, hypertension, recent colonoscopy 12/12 who presented to ED on 12/17 after being found on floor by son.
She reportedly had poor oral intake and diarrhea in the preceding days.
In ED she was hypothermic and hypotensive with altered mental status.
She became increasingly agitated, ultimately requiring intubation.
Laboratory studies were significant for profound acidosis (PH 6.
7), lactic acid (25), acute renal failure (BUN 56/creat 10.
45), leukocytosis (34,000), and she was influenza A positive.
CXR showed possible RLL infiltrate.
CT angio abdomen showed mild nonspecific pan colitis, vascular exam unremarkable.
CT head and c-spine without acute process/fracture.
She received bicarb push x 2, hydrocortisone 100 mg, 4L IVF and Tamiflu.
She was transferred to ICU in florid shock, requiring up to four vasopressors and bicarb drip.
Given Metformin use and severely elevated lactic acid, it was suspected that she was suffering from Metformin toxicity.
She was started on empiric antibiotics, including Cefepime, Flagyl and Vancomycin.
She was also started on Tamiflu.
She was noted to test positive for COVID-19 as well on admission to ICU, in addition to influenza A.
Vascular catheter was placed and continuous renal replacement therapy was started 12/17.
Her acidosis cleared and vasopressors were slowly weaned down.
She was able to be weaned off sedation by 12/21, and was extubated on 12/23.
Continuous renal replacement therapy was stopped 12/24 and she was transitioned to hemodialysis.
She had a run of hemodialysis on 12/26, but then had progressive improvement in her renal function with increased urine output, such that dialysis was no longer felt to be required.
Vascular catheter was removed on 12/28.
Patient transferred to the hospitalist service 12/25/2022.
She had completed a full course of antibiotics while in the intensive care unit for pneumonia and completed 5-days of Tamiflu therapy for influenza A.
She developed acute worsening in anemia on 12/28, requiring 1 unit packed red blood cells, with hemoglobin stable around 8-8.
5 g/dL thereafter.
Her blood sugars remained stable on low dose corrective Humalog, and A1c was normal at 6.
0%.
She was felt stable for discharge home on 12/31/22.
She will need follow-up CBC and CMP in 5 days to recheck renal function and hemoglobin.
I am going to keep her off of chlorthalidone, glipizide, Janumet, metformin and losartan at discharge.
She will continue simvastatin and Ozempic.
She should follow-up her PCP in 1 week.
She should establish care with local nephrologist, given high likelihood for ongoing renal dysfunction/CKD in the setting of her severe AKI.