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This is VAERS ID 1079864

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1079864
VAERS Form:2
Age:83.0
Sex:Male
Location:California
Vaccinated:2021-02-23
Onset:2021-03-04
Submitted:0000-00-00
Entered:2021-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: CSF protein increased, Dyspnoea, Guillain-Barre syndrome, Respiratory failure, Musculoskeletal disorder, Magnetic resonance imaging normal

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None.
Current Illness: Recovering from Guillain-Barre Syndrome triggered by COVID December 2020. Was ambulatory again at the time of vaccination.
Preexisting Conditions: h/o CAD. s/p CABG x 5 10 years ago.
Allergies: Abalone.
Diagnostic Lab Data: increased protein in CSF. No changes on MRI.
CDC 'Split Type':

Write-up: 9 days after receiving vaccine, pt developed rapid onset of ascending paralysis. No use of legs, minimal use of right arm. Limited use of left arm. Repiratory difficulty/failure.


Changed on 5/7/2021

VAERS ID: 1079864 Before After
VAERS Form:2
Age:83.0
Sex:Male
Location:California
Vaccinated:2021-02-23
Onset:2021-03-04
Submitted:0000-00-00
Entered:2021-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: CSF protein increased, Dyspnoea, Guillain-Barre syndrome, Respiratory failure, Musculoskeletal disorder, Magnetic resonance imaging normal

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None.
Current Illness: Recovering from Guillain-Barre Syndrome triggered by COVID December 2020. Was ambulatory again at the time of vaccination.
Preexisting Conditions: h/o CAD. s/p CABG x 5 10 years ago.
Allergies: Abalone. Abalone.
Diagnostic Lab Data: increased protein in CSF. No changes on MRI.
CDC 'Split Type':

Write-up: 9 days after receiving vaccine, pt developed rapid onset of ascending paralysis. No use of legs, minimal use of right arm. Limited use of left arm. Repiratory difficulty/failure.


Changed on 5/21/2021

VAERS ID: 1079864 Before After
VAERS Form:2
Age:83.0
Sex:Male
Location:California
Vaccinated:2021-02-23
Onset:2021-03-04
Submitted:0000-00-00
Entered:2021-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EN6203 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: CSF protein increased, Dyspnoea, Guillain-Barre syndrome, Respiratory failure, Musculoskeletal disorder, Magnetic resonance imaging normal

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None.
Current Illness: Recovering from Guillain-Barre Syndrome triggered by COVID December 2020. Was ambulatory again at the time of vaccination.
Preexisting Conditions: h/o CAD. s/p CABG x 5 10 years ago.
Allergies: Abalone. Abalone.
Diagnostic Lab Data: increased protein in CSF. No changes on MRI.
CDC 'Split Type':

Write-up: 9 days after receiving vaccine, pt developed rapid onset of ascending paralysis. No use of legs, minimal use of right arm. Limited use of left arm. Repiratory difficulty/failure.

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