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This is VAERS ID 1036182

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1036182
VAERS Form:2
Age:80.0
Sex:Male
Location:Colorado
Vaccinated:2021-02-12
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Areflexia, Coma, Cough, Death, Intracranial aneurysm, Intracranial pressure increased, Intraventricular haemorrhage, Ophthalmoplegia, Posturing, Pupillary light reflex tests abnormal, Pupillary reflex impaired, Ruptured cerebral aneurysm, Subarachnoid haemorrhage, Syncope, Unresponsive to stimuli, Ventricular drainage, Agonal rhythm, Mechanical ventilation, Coma scale abnormal, Computerised tomogram head abnormal, Posthaemorrhagic hydrocephalus, Hunt and Hess scale

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-13
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Not verified. EMR states 1/4/2021 SINEMET 25-100 mg tablet.
Current Illness: Unknown
Preexisting Conditions: Not verified. Problem list in EMR includes: Cerebellar ataxia Noted 7/28/2017, Parkinson''s disease Noted 10/11/2019, Peripheral polyneuropathy Noted 7/29/2017, Lumbar radiculopathy Noted 10/29/2020, Throat clearing Noted 1/22/2018, Oropharyngeal dysphagia Noted 10/11/2019, Aortic ectasia Noted 10/6/2019, Anterior communicating artery aneurysm Noted 7/28/2017, Essential hypertension Noted 7/28/2017, Constipation Noted 10/23/2019, Nocturia Noted 10/11/2019, Dupuytren''s disease of palm of both hands Noted 10/11/2019, Alcohol intake above recommended sensible limits with complication Noted 7/29/2017, Major depressive disorder, single episode, mild Noted 10/11/2019, Hoarseness Noted 1/22/2018.
Allergies: NKA
Diagnostic Lab Data: CT Head w/o contrast - extensive subarachnoid & intraventricular hemorrhage most probably related to a bleeding anterior communicating artery aneurysm.
CDC 'Split Type':

Write-up: Patient received 2nd dose of the COVID-19 Pfizer vaccine, was observed in office x 15+ minutes, and released home. Pt and his son exited the building and when they got to the car, the pt shouted out "oh no!" and collapsed to the ground. The patient was unconscious experiencing agonal respirations, and unresponsive to painful stimuli. There is an Emergency Room at the same location. Their staff came out and helped to transfer the pt to the ED for further evaluation. It was found that the patient had a known Anterior communicating artery aneurysm (7/28/2017) that seemed to have ruptured. The patient was stabilized and transported to our local hospital and upon arrival, he was effectively comatose with a GCS 3. CT Head notated an extensive subarachnoid and intraventricular hemorrhage most probably related to a bleeding anterior communicating artery aneurysm. Neuro-Interventional Radiologist dictation reads "Hunt Hess 5 Fisher grade 4 extensive subarachnoid hemorrhage with intraventricular hemorrhage and early hydrocephalus secondary to rupture of a known anterior communicating artery aneurysm. Initial ICP after EVD placement noted to be in the 120s now 68 treatment complicated by aneurysm rerupture after admission and increased volume of blood although large volume of hemorrhage was seen on initial scan and no change in the patient''s clinical exam on her scale was noted due to this rerupture. Patient''s exam and prognosis are poor giving extensor posturing lack of extraocular movements to doll''s maneuver and weak pupillary reflex as well as cough and gag. Follows no commands or instructions at this time with no spontaneous movement on ventilator set at 12 overbreathing at 14-16 at this time without any sedation." The family opted to discontinue any further treatment to include surgical intervention given the findings. The patient was given comfort care with son and daughter at the bedside. The patient was extubated and expired at 1545h on 2/13/2021.


Changed on 5/7/2021

VAERS ID: 1036182 Before After
VAERS Form:2
Age:80.0
Sex:Male
Location:Colorado
Vaccinated:2021-02-12
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Areflexia, Coma, Cough, Death, Intracranial aneurysm, Intracranial pressure increased, Intraventricular haemorrhage, Ophthalmoplegia, Posturing, Pupillary light reflex tests abnormal, Pupillary reflex impaired, Ruptured cerebral aneurysm, Subarachnoid haemorrhage, Syncope, Unresponsive to stimuli, Ventricular drainage, Agonal rhythm, Mechanical ventilation, Coma scale abnormal, Computerised tomogram head abnormal, Posthaemorrhagic hydrocephalus, Hunt and Hess scale

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-13
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Not verified. EMR states 1/4/2021 SINEMET 25-100 mg tablet.
Current Illness: Unknown
Preexisting Conditions: Not verified. Problem list in EMR includes: Cerebellar ataxia Noted 7/28/2017, Parkinson''s disease Noted 10/11/2019, Peripheral polyneuropathy Noted 7/29/2017, Lumbar radiculopathy Noted 10/29/2020, Throat clearing Noted 1/22/2018, Oropharyngeal dysphagia Noted 10/11/2019, Aortic ectasia Noted 10/6/2019, Anterior communicating artery aneurysm Noted 7/28/2017, Essential hypertension Noted 7/28/2017, Constipation Noted 10/23/2019, Nocturia Noted 10/11/2019, Dupuytren''s disease of palm of both hands Noted 10/11/2019, Alcohol intake above recommended sensible limits with complication Noted 7/29/2017, Major depressive disorder, single episode, mild Noted 10/11/2019, Hoarseness Noted 1/22/2018.
Allergies: NKA NKA
Diagnostic Lab Data: CT Head w/o contrast - extensive subarachnoid & intraventricular hemorrhage most probably related to a bleeding anterior communicating artery aneurysm.
CDC 'Split Type':

Write-up: Patient received 2nd dose of the COVID-19 Pfizer vaccine, was observed in office x 15+ minutes, and released home. Pt and his son exited the building and when they got to the car, the pt shouted out "oh no!" and collapsed to the ground. The patient was unconscious experiencing agonal respirations, and unresponsive to painful stimuli. There is an Emergency Room at the same location. Their staff came out and helped to transfer the pt to the ED for further evaluation. It was found that the patient had a known Anterior communicating artery aneurysm (7/28/2017) that seemed to have ruptured. The patient was stabilized and transported to our local hospital and upon arrival, he was effectively comatose with a GCS 3. CT Head notated an extensive subarachnoid and intraventricular hemorrhage most probably related to a bleeding anterior communicating artery aneurysm. Neuro-Interventional Radiologist dictation reads "Hunt Hess 5 Fisher grade 4 extensive subarachnoid hemorrhage with intraventricular hemorrhage and early hydrocephalus secondary to rupture of a known anterior communicating artery aneurysm. Initial ICP after EVD placement noted to be in the 120s now 68 treatment complicated by aneurysm rerupture after admission and increased volume of blood although large volume of hemorrhage was seen on initial scan and no change in the patient''s clinical exam on her scale was noted due to this rerupture. Patient''s exam and prognosis are poor giving extensor posturing lack of extraocular movements to doll''s maneuver and weak pupillary reflex as well as cough and gag. Follows no commands or instructions at this time with no spontaneous movement on ventilator set at 12 overbreathing at 14-16 at this time without any sedation." The family opted to discontinue any further treatment to include surgical intervention given the findings. The patient was given comfort care with son and daughter at the bedside. The patient was extubated and expired at 1545h on 2/13/2021.


Changed on 5/14/2021

VAERS ID: 1036182 Before After
VAERS Form:2
Age:80.0
Sex:Male
Location:Colorado
Vaccinated:2021-02-12
Onset:2021-02-12
Submitted:0000-00-00
Entered:2021-02-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6201 / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Areflexia, Coma, Cough, Death, Intracranial aneurysm, Intracranial pressure increased, Intraventricular haemorrhage, Ophthalmoplegia, Posturing, Pupillary light reflex tests abnormal, Pupillary reflex impaired, Ruptured cerebral aneurysm, Subarachnoid haemorrhage, Syncope, Unresponsive to stimuli, Ventricular drainage, Agonal rhythm, Mechanical ventilation, Coma scale abnormal, Computerised tomogram head abnormal, Posthaemorrhagic hydrocephalus, Hunt and Hess scale

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-13
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Not verified. EMR states 1/4/2021 SINEMET 25-100 mg tablet.
Current Illness: Unknown
Preexisting Conditions: Not verified. Problem list in EMR includes: Cerebellar ataxia Noted 7/28/2017, Parkinson''s disease Noted 10/11/2019, Peripheral polyneuropathy Noted 7/29/2017, Lumbar radiculopathy Noted 10/29/2020, Throat clearing Noted 1/22/2018, Oropharyngeal dysphagia Noted 10/11/2019, Aortic ectasia Noted 10/6/2019, Anterior communicating artery aneurysm Noted 7/28/2017, Essential hypertension Noted 7/28/2017, Constipation Noted 10/23/2019, Nocturia Noted 10/11/2019, Dupuytren''s disease of palm of both hands Noted 10/11/2019, Alcohol intake above recommended sensible limits with complication Noted 7/29/2017, Major depressive disorder, single episode, mild Noted 10/11/2019, Hoarseness Noted 1/22/2018.
Allergies: NKA NKA
Diagnostic Lab Data: CT Head w/o contrast - extensive subarachnoid & intraventricular hemorrhage most probably related to a bleeding anterior communicating artery aneurysm.
CDC 'Split Type':

Write-up: Patient received 2nd dose of the COVID-19 Pfizer vaccine, was observed in office x 15+ minutes, and released home. Pt and his son exited the building and when they got to the car, the pt shouted out "oh no!" and collapsed to the ground. The patient was unconscious experiencing agonal respirations, and unresponsive to painful stimuli. There is an Emergency Room at the same location. Their staff came out and helped to transfer the pt to the ED for further evaluation. It was found that the patient had a known Anterior communicating artery aneurysm (7/28/2017) that seemed to have ruptured. The patient was stabilized and transported to our local hospital and upon arrival, he was effectively comatose with a GCS 3. CT Head notated an extensive subarachnoid and intraventricular hemorrhage most probably related to a bleeding anterior communicating artery aneurysm. Neuro-Interventional Radiologist dictation reads "Hunt Hess 5 Fisher grade 4 extensive subarachnoid hemorrhage with intraventricular hemorrhage and early hydrocephalus secondary to rupture of a known anterior communicating artery aneurysm. Initial ICP after EVD placement noted to be in the 120s now 68 treatment complicated by aneurysm rerupture after admission and increased volume of blood although large volume of hemorrhage was seen on initial scan and no change in the patient''s clinical exam on her scale was noted due to this rerupture. Patient''s exam and prognosis are poor giving extensor posturing lack of extraocular movements to doll''s maneuver and weak pupillary reflex as well as cough and gag. Follows no commands or instructions at this time with no spontaneous movement on ventilator set at 12 overbreathing at 14-16 at this time without any sedation." The family opted to discontinue any further treatment to include surgical intervention given the findings. The patient was given comfort care with son and daughter at the bedside. The patient was extubated and expired at 1545h on 2/13/2021.

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