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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1066906

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Case Details

VAERS ID: 1066906 (history)  
Form: Version 2.0  
Age: 92.0  
Sex: Male  
Location: New York  
Vaccinated:2020-12-30
Onset:2021-02-01
   Days after vaccination:33
Submitted: 0000-00-00
Entered: 2021-03-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Asthenia, Axonal and demyelinating polyneuropathy, COVID-19, Computerised tomogram spine, Death, Electromyogram abnormal, Guillain-Barre syndrome, Immunoglobulin therapy, Magnetic resonance imaging brain normal, Mental status changes, Mobility decreased, Movement disorder, Polyneuropathy, Spinal myelogram normal, Urinary tract infection
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Dementia (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Demyelination (narrow), Tendinopathies and ligament disorders (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died: 2021-02-14
   Days after onset: 13
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 10 days
   Extended hospital stay? No
Previous Vaccinations: Influenza Vaccine
Other Medications: ACETAMINOPHEN 325 MG TABLET (.) TWO TAB(S) by mouth every 6 hours prn MAXIMUM OF 3.90 GRAMS (3900MG) OF ACETAMINOPHEN PER DAY . *12 TABLETS* dx pain, ACETAMINOPHEN 325 MG TABLET (.) TWO TAB(S) by mouth two times per day (09:00, 17:00) M
Current Illness: Dementia with behavioral disturbances.
Preexisting Conditions: 1. CAD 2. Leg edema 3. BPH 4. Vascular dementia 5. MDD/behavioral disturbances 6. Sleep wake disturbance 7. Hx BCC posterior neck 8. B/L hips and right knee OA 9. Hyponatremia
Allergies: No known allergies.
Diagnostic Lab Data: See history above.
CDC Split Type:

Write-up: 92 year-old male with PMHx of vascular dementia, BPH, MDD, sleep disturbance , basal cell carcinoma of neck, osteoarthritis, BLE edema, Guillain-Barre syndrome 30 years prior, s/p COVID positive on 1/11/21 and received IV Bamlanivimab. Sent to hospital on 2/2/21 for altered mental status, generalized weakness with inability to lift bilateral UE and difficulty moving his BLE. He was treated for UTI with 7 days of Cefepime for Morganella Morganii. He was followed by neurology with MRI of the brain and CT of the spine without acute findings. Lumbar puncture unable to be obtained. He received 5 day course of IVIG for presumed Guillain-Barre . EMG showed generalized sensory motor polyneuropathy both axon loss and demyelinating type severe in degree. However, he did not recover from his GBS symptoms, was transferred back to the nursing home and died on 2/15/2021.


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