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This is VAERS ID 1080751

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1080751
VAERS Form:2
Age:62.0
Sex:Female
Location:Texas
Vaccinated:2021-02-24
Onset:2021-02-25
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 RA / SYR

Administered by: Public      Purchased by: ??
Symptoms: Back pain, Chest pain, Gait inability, Guillain-Barre syndrome, Hypertension, Hypoaesthesia, Nausea, Vomiting, Musculoskeletal disorder, Acute motor-sensory axonal neuropathy

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)? Yes
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxicillin 875mg; Hydrochlorothiazide 25mg; Hydrocodone 7.5mg; Letrozole 2.5mg; Losartan Potassium 50mg; Potassium Chloride 20 Meq; Raloxifene Hcl 60mg; Tizanidine Hcl 4mg All daily except hydrocodone and tizanidine
Current Illness: Bronchitis
Preexisting Conditions: High Blood Pressure; Breast Cancer Survivor
Allergies: Unknown at this time
Diagnostic Lab Data: Acute Sensory Axonal Neuropathy a severe/rare case of Guillain-Barre Syndrome.
CDC 'Split Type':

Write-up: High blood pressure; chest pain; back pain; numbness in limbs; nausea and vomiting.; inability to walk or move legs and feet. Was officially diagnosed on 2/5/2021 wit Acute Sensory Axonal Neuropathy a severe/rare case of Guillain-Barre Syndrome. Unknown time for recovery. Is in the process of being referred to a rehab center.


Changed on 5/7/2021

VAERS ID: 1080751 Before After
VAERS Form:2
Age:62.0
Sex:Female
Location:Texas
Vaccinated:2021-02-24
Onset:2021-02-25
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 RA / SYR

Administered by: Public      Purchased by: ??
Symptoms: Back pain, Chest pain, Gait inability, Guillain-Barre syndrome, Hypertension, Hypoaesthesia, Nausea, Vomiting, Musculoskeletal disorder, Acute motor-sensory axonal neuropathy

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)? Yes
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxicillin 875mg; Hydrochlorothiazide 25mg; Hydrocodone 7.5mg; Letrozole 2.5mg; Losartan Potassium 50mg; Potassium Chloride 20 Meq; Raloxifene Hcl 60mg; Tizanidine Hcl 4mg All daily except hydrocodone and tizanidine
Current Illness: Bronchitis
Preexisting Conditions: High Blood Pressure; Breast Cancer Survivor
Allergies: Unknown at this time time
Diagnostic Lab Data: Acute Sensory Axonal Neuropathy a severe/rare case of Guillain-Barre Syndrome.
CDC 'Split Type':

Write-up: High blood pressure; chest pain; back pain; numbness in limbs; nausea and vomiting.; inability to walk or move legs and feet. Was officially diagnosed on 2/5/2021 wit Acute Sensory Axonal Neuropathy a severe/rare case of Guillain-Barre Syndrome. Unknown time for recovery. Is in the process of being referred to a rehab center.


Changed on 5/21/2021

VAERS ID: 1080751 Before After
VAERS Form:2
Age:62.0
Sex:Female
Location:Texas
Vaccinated:2021-02-24
Onset:2021-02-25
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 043L20A / 2 RA / SYR

Administered by: Public      Purchased by: ??
Symptoms: Back pain, Chest pain, Gait inability, Guillain-Barre syndrome, Hypertension, Hypoaesthesia, Nausea, Vomiting, Musculoskeletal disorder, Acute motor-sensory axonal neuropathy

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)? Yes
Hospitalized? Yes, days: 12     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxicillin 875mg; Hydrochlorothiazide 25mg; Hydrocodone 7.5mg; Letrozole 2.5mg; Losartan Potassium 50mg; Potassium Chloride 20 Meq; Raloxifene Hcl 60mg; Tizanidine Hcl 4mg All daily except hydrocodone and tizanidine
Current Illness: Bronchitis
Preexisting Conditions: High Blood Pressure; Breast Cancer Survivor
Allergies: Unknown at this time time
Diagnostic Lab Data: Acute Sensory Axonal Neuropathy a severe/rare case of Guillain-Barre Syndrome.
CDC 'Split Type':

Write-up: High blood pressure; chest pain; back pain; numbness in limbs; nausea and vomiting.; inability to walk or move legs and feet. Was officially diagnosed on 2/5/2021 wit Acute Sensory Axonal Neuropathy a severe/rare case of Guillain-Barre Syndrome. Unknown time for recovery. Is in the process of being referred to a rehab center.

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