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This is VAERS ID 1042458

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 1042458
VAERS Form:2
Age:77.0
Sex:Male
Location:California
Vaccinated:2021-01-26
Onset:2021-02-16
Submitted:0000-00-00
Entered:2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Cerebral infarction, Cerebrovascular accident, Thrombosis, Computerised tomogram head, Angiogram, Hyperlipidaemia, Magnetic resonance imaging brain abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eye drops for glaucoma, omeprazole
Current Illness: None
Preexisting Conditions: Glaucoma
Allergies: None
Diagnostic Lab Data: 2/16/21 CT head: (similar findings on subsequent CT angio and MRI) Large low-density area in left posterior MCA distribution consistent with an acute to early subacute infarct with local mass effect and sulcal effacement as discussed above. There are high density left middle cerebral artery posterior sylvian branches suspicious for thrombosis.
CDC 'Split Type':

Write-up: Patient admitted with acute stroke, no prior history of same. Mild hyperlipidemia, but otherwise no clear risk factors for stroke. Unclear if anything to do with COVID vaccine.


Changed on 5/7/2021

VAERS ID: 1042458 Before After
VAERS Form:2
Age:77.0
Sex:Male
Location:California
Vaccinated:2021-01-26
Onset:2021-02-16
Submitted:0000-00-00
Entered:2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Cerebral infarction, Cerebrovascular accident, Thrombosis, Computerised tomogram head, Angiogram, Hyperlipidaemia, Magnetic resonance imaging brain abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eye drops for glaucoma, omeprazole
Current Illness: None
Preexisting Conditions: Glaucoma
Allergies: None None
Diagnostic Lab Data: 2/16/21 CT head: (similar findings on subsequent CT angio and MRI) Large low-density area in left posterior MCA distribution consistent with an acute to early subacute infarct with local mass effect and sulcal effacement as discussed above. There are high density left middle cerebral artery posterior sylvian branches suspicious for thrombosis.
CDC 'Split Type':

Write-up: Patient admitted with acute stroke, no prior history of same. Mild hyperlipidemia, but otherwise no clear risk factors for stroke. Unclear if anything to do with COVID vaccine.


Changed on 5/21/2021

VAERS ID: 1042458 Before After
VAERS Form:2
Age:77.0
Sex:Male
Location:California
Vaccinated:2021-01-26
Onset:2021-02-16
Submitted:0000-00-00
Entered:2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Cerebral infarction, Cerebrovascular accident, Thrombosis, Computerised tomogram head, Angiogram, Hyperlipidaemia, Magnetic resonance imaging brain abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Eye drops for glaucoma, omeprazole
Current Illness: None
Preexisting Conditions: Glaucoma
Allergies: None None
Diagnostic Lab Data: 2/16/21 CT head: (similar findings on subsequent CT angio and MRI) Large low-density area in left posterior MCA distribution consistent with an acute to early subacute infarct with local mass effect and sulcal effacement as discussed above. There are high density left middle cerebral artery posterior sylvian branches suspicious for thrombosis.
CDC 'Split Type':

Write-up: Patient admitted with acute stroke, no prior history of same. Mild hyperlipidemia, but otherwise no clear risk factors for stroke. Unclear if anything to do with COVID vaccine.

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