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This is VAERS ID 1129176

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1129176
VAERS Form:2
Age:73.0
Sex:Male
Location:Florida
Vaccinated:2021-02-06
Onset:2021-02-07
Submitted:0000-00-00
Entered:2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Cerebral infarction, Computerised tomogram, Echocardiogram, Visual field defect, Scan with contrast, Magnetic resonance imaging

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)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril: 20mg daily Metoprolol: 25mg daily Aspirin: 81mg daily Fluticasone Propionate: 50mcg 1 spray in each nostril daily Atorvastatin (Lipitor): 20mg daily Xarelto: 20mg daily Multivitamin: daily Vitamin B12: 1000mcg daily
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data: CT scan w/o contrast - 2/9/2021 CT scan with contrast - 2/9/2021 TEE - 2/11/2021 MRI - 2/11/2021
CDC 'Split Type':

Write-up: Within 12 hours of receiving the 2nd dose of the Moderna vaccine, I experienced an occipital cerebral infarction in the left occipital lobe. As a result, I have a loss of peripheral vision in the right upper quadrant.


Changed on 5/7/2021

VAERS ID: 1129176 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Florida
Vaccinated:2021-02-06
Onset:2021-02-07
Submitted:0000-00-00
Entered:2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Cerebral infarction, Computerised tomogram, Echocardiogram, Visual field defect, Scan with contrast, Magnetic resonance imaging

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)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril: 20mg daily Metoprolol: 25mg daily Aspirin: 81mg daily Fluticasone Propionate: 50mcg 1 spray in each nostril daily Atorvastatin (Lipitor): 20mg daily Xarelto: 20mg daily Multivitamin: daily Vitamin B12: 1000mcg daily
Current Illness:
Preexisting Conditions:
Allergies: Penicillin Penicillin
Diagnostic Lab Data: CT scan w/o contrast - 2/9/2021 CT scan with contrast - 2/9/2021 TEE - 2/11/2021 MRI - 2/11/2021
CDC 'Split Type':

Write-up: Within 12 hours of receiving the 2nd dose of the Moderna vaccine, I experienced an occipital cerebral infarction in the left occipital lobe. As a result, I have a loss of peripheral vision in the right upper quadrant.


Changed on 5/14/2021

VAERS ID: 1129176 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Florida
Vaccinated:2021-02-06
Onset:2021-02-07
Submitted:0000-00-00
Entered:2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L20A / 2 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Cerebral infarction, Computerised tomogram, Echocardiogram, Visual field defect, Scan with contrast, Magnetic resonance imaging

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)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril: 20mg daily Metoprolol: 25mg daily Aspirin: 81mg daily Fluticasone Propionate: 50mcg 1 spray in each nostril daily Atorvastatin (Lipitor): 20mg daily Xarelto: 20mg daily Multivitamin: daily Vitamin B12: 1000mcg daily
Current Illness:
Preexisting Conditions:
Allergies: Penicillin Penicillin
Diagnostic Lab Data: CT scan w/o contrast - 2/9/2021 CT scan with contrast - 2/9/2021 TEE - 2/11/2021 MRI - 2/11/2021
CDC 'Split Type':

Write-up: Within 12 hours of receiving the 2nd dose of the Moderna vaccine, I experienced an occipital cerebral infarction in the left occipital lobe. As a result, I have a loss of peripheral vision in the right upper quadrant.

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