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This is VAERS ID 1110537

History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1110537
VAERS Form:2
Age:79.0
Sex:Male
Location:Nebraska
Vaccinated:2021-03-12
Onset:2021-03-15
Submitted:0000-00-00
Entered:2021-03-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 040A21A / 2 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Brain herniation, Cerebral haemorrhage, Neurological symptom, Cerebral mass effect, Endotracheal intubation, Computerised tomogram head abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-03-15
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ACETAMINOPHEN, AMIODARONE, ELIQUIS, LEVOTHYROXINE, LOSATAN, PRIMADONE, TRIMETHOPRIM, NORCOAR, VALIUM
Current Illness: FX FEMUR
Preexisting Conditions: A-FIB, ARTHRITIS, COLON CA COPD, SAD, GERD, HYPERSHOLESTEREMIA, HYPERTENSION, NEUROPATHY
Allergies: NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was found to be having stroke like symptoms 3/15 in the morning at nursing home. he was evaluated and was transported by ambulance from one hospital to another hospital as the CT scanner was down. patient had an injury on march 1 with a cabinet falling on him breaking his femur and family not sure if at that time he had hit his head. Patient was intubated in the ER CT scan showed a massive cerebral bleed with midline shift and transtentorial herniation

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