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This is VAERS ID 1066906

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/5/2021

VAERS ID: 1066906
VAERS Form:2
Age:92.0
Sex:Male
Location:New York
Vaccinated:2020-12-30
Onset:2021-02-01
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, Death, Electromyogram abnormal, Guillain-Barre syndrome, Movement disorder, Polyneuropathy, Urinary tract infection, Mental status changes, Mobility decreased, Spinal myelogram normal, Immunoglobulin therapy, Computerised tomogram spine, Magnetic resonance imaging brain normal, Axonal and demyelinating polyneuropathy, COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     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.


Changed on 5/7/2021

VAERS ID: 1066906 Before After
VAERS Form:2
Age:92.0
Sex:Male
Location:New York
Vaccinated:2020-12-30
Onset:2021-02-01
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, Death, Electromyogram abnormal, Guillain-Barre syndrome, Movement disorder, Polyneuropathy, Urinary tract infection, Mental status changes, Mobility decreased, Spinal myelogram normal, Immunoglobulin therapy, Computerised tomogram spine, Magnetic resonance imaging brain normal, Axonal and demyelinating polyneuropathy, COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     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. 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.


Changed on 5/21/2021

VAERS ID: 1066906 Before After
VAERS Form:2
Age:92.0
Sex:Male
Location:New York
Vaccinated:2020-12-30
Onset:2021-02-01
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, Death, Electromyogram abnormal, Guillain-Barre syndrome, Movement disorder, Polyneuropathy, Urinary tract infection, Mental status changes, Mobility decreased, Spinal myelogram normal, Immunoglobulin therapy, Computerised tomogram spine, Magnetic resonance imaging brain normal, Axonal and demyelinating polyneuropathy, COVID-19

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-14
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     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. 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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