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This is VAERS ID 1300411

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1300411
VAERS Form:2
Age:59.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-04-22
Onset:2021-05-02
Submitted:0000-00-00
Entered:2021-05-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0171 / 2 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Alanine aminotransferase normal, Anion gap normal, Aspartate aminotransferase normal, Basophil count normal, Bilirubin conjugated normal, Blindness, Blood albumin, Blood alkaline phosphatase normal, Blood bicarbonate, Blood calcium normal, Blood chloride normal, Blood cholesterol normal, Blood creatinine increased, Blood glucose normal, Blood immunoglobulin M, Blood magnesium normal, Blood potassium normal, Blood sodium normal, Blood triglycerides normal, Blood urea normal, Cardiolipin antibody, Cerebrovascular accident, Eosinophil count decreased, Full blood count, Glomerular filtration rate normal, Haematocrit decreased, Haemoglobin normal, Heart rate decreased, Hypotension, Lymphocyte count normal, Mean cell volume, Monocyte count decreased, Nausea, Neutrophil count normal, Platelet count normal, Protein total normal, Red blood cell count increased, Vomiting, White blood cell count, Brain death, Red blood cell sedimentation rate normal, Balance disorder, Beta 2 microglobulin, Computerised tomogram head, Troponin I increased, Antiphospholipid antibodies negative, Analgesic drug level, Blood electrolytes, Metabolic function test, SARS-CoV-2 test negative

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)? Yes
Hospitalized? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Famotidine tums tumeric garlic C50 Vitamin B multivitamin
Current Illness: none
Preexisting Conditions: none
Allergies: laytex, narcotic pain meds, gabapentin,
Diagnostic Lab Data: Metabolic/Electrolyte Panel May 6, 2021 CT HEAD WITHOUT IV CONTRAST May 5, 2021 Complete Blood Count May 5, 2021 CARDIOLIPIN ANTIBODY May 4, 2021 BETA 2 GP1 AB, IGM/IGG, S May 4, 202 Metabolic/Electrolyte Panel May 6, 2021 Potassium, P 4.0 mmol/L 3.6 - 5.2 mmol/L Sodium, P 137 mmol/L 135 - 145 mmol/L Chloride, P 104 mmol/L 98 - 107 mmol/L Bicarbonate, P 24 mmol/L 22 - 29 mmol/L Anion Gap, P 9 7 - 15 BUN, P 14 mg/dL 8 - 24 mg/dL Creatinine, P 1.25 mg/dL 0.74 - 1.35 mg/dL Calcium, Total, P 9.2 mg/dL 8.6 - 10.0 mg/dL Glucose, P 129 mg/dL 70 - 140 mg/dL CT HEAD WITHOUT IV CONTRAST May 5, 2021 FINDINGS: Large region of encephalomalacia involving the central and inferior right cerebellar hemisphere appears similar when compared with 05/04/2021 consistent with an evolving large right cerebellar hemisphere. No new infarcts. No intracranial hemorrhage, mass, mass effect, shift of the midline structures, ventriculomegaly, or new infarcts. Osseous structures are negative. Soft tissues within normal limits. No change. Complete Blood Count May 5, 2021 Hemoglobin 13.9 g/dL 13.2 - 16.6 g/dL Hematocrit 40.5 % 38.3 - 48.6 % Erythrocytes 4.48 x10(12)/L 4.35 - 5.65 x10(12)/L MCV 90.4 fL 78.2 - 97.9 fL RBC Distrib Width 11.9 % 11.8 - 14.5 % Platelet Count 224 x10(9)/L 135 - 317 x10(9)/L Leukocytes 8.7 x10(9)/L 3.4 - 9.6 x10(9)/L Neutrophils 5.78 x10(9)/L 1.56 - 6.45 x10(9)/L Lymphocytes 2.02 x10(9)/L 0.95 - 3.07 x10(9)/L Monocytes 0.74 x10(9)/L 0.26 - 0.81 x10(9)/L Eosinophils 0.09 x10(9)/L 0.03 - 0.48 x10(9)/L Basophils 0.05 x10(9)/L 0.01 - 0.08 x10(9)/L CARDIOLIPIN ANTIBODY May 4, 2021 Phospholipid Ab IgM, S <9.4 MPL <15.0 (Negative) MPL Phospholipid Ab IgG, S <9.4 GPL <15.0 (Negative) GPL General Information BETA 2 GP1 AB, IGM/IGG, S May 4, 2021 Beta 2 GP1 Ab IgG, S <9.4 U/mL <15.0 (Negative) U/mL Beta 2 GP1 Ab IgM, S <9.4 U/mL <15.0 (Negative) U/mL CT HEAD WITHOUT IV CONTRAST May 4, 2021 Routine CT of the head without contrast. No acute intracranial hemorrhage. No midline shift or mass effect. Mild central volume loss. Ventricles are mildly prominent, but are not significantly changed in the interval. Basilar cisterns are patent. No significant change in appearance of the fourth ventricle. Poorly defined area of decreased attenuation is identified throughout the right cerebellum, representing an area of evolving infarct. This has progressed compared to the CT from 5/2/2021. There is associated vasogenic edema and some mass effect. However, there is not significant change in morphology of the fourth ventricle. Some mass effect extends across the midline. No definite extra-axial fluid collection. Mild mucosal thickening along the paranasal sinuses. Complete Blood Count May 4, 2021 Hemoglobin 13.9 g/dL 13.2 - 16.6 g/dL Hematocrit 40.7 % 38.3 - 48.6 % Erythrocytes 4.44 x10(12)/L 4.35 - 5.65 x10(12)/L MCV 91.7 fL 78.2 - 97.9 fL RBC Distrib Width 12.0 % 11.8 - 14.5 % Platelet Count 225 x10(9)/L 135 - 317 x10(9)/L Leukocytes 8.0 x10(9)/L 3.4 - 9.6 x10(9)/L Neutrophils 4.81 x10(9)/L 1.56 - 6.45 x10(9)/L Lymphocytes 2.37 x10(9)/L 0.95 - 3.07 x10(9)/L Monocytes 0.71 x10(9)/L 0.26 - 0.81 x10(9)/L Eosinophils 0.09 x10(9)/L 0.03 - 0.48 x10(9)/L Basophils 0.04 x10(9)/L 0.01 - 0.08 x10(9)/L Metabolic/Electrolyte Panel May 4, 2021 Potassium, P 3.7 mmol/L 3.6 - 5.2 mmol/L Sodium, P 140 mmol/L 135 - 145 mmol/L Chloride, P 107 mmol/L 98 - 107 mmol/L Bicarbonate, P 23 mmol/L 22 - 29 mmol/L Anion Gap, P 10 7 - 15 BUN, P 14 mg/dL 8 - 24 mg/dL Creatinine, P 1.24 mg/dL 0.74 - 1.35 mg/dL eGFR Black 73 mL/min/BSA $g=60 mL/min/BSA ----ADDITIONAL INFORMATION---- Estimated GFR calculated using the 2009 CKD_EPI creatinine equation. eGFR Non-Black 63 mL/min/BSA $g=60 mL/min/BSA ----ADDITIONAL INFORMATION---- Estimated GFR calculated using the 2009 CKD_EPI creatinine equation. Calcium, Total, P 8.9 mg/dL 8.6 - 10.0 mg/dL Glucose, P 114 mg/dL 70 - 140 mg/dL MR BRAIN WITHOUT IV CONTRAST May 3, 2021 FINDINGS: Noncontrast brain MRI shows a large region of diffusion restriction, dark ADC signal involving the inferior right cerebellar hemisphere extending to the superior lateral right cerebellar hemisphere consistent with acute ischemia. There is some increased FLAIR, T2 signal noted. There is no evidence for petechial hemorrhage by MRI at this time. There is no structural abnormality Scattered areas of white matter signal in the cerebral hemispheres consistent with mild leukoaraiosis No supratentorial ischemia. There is no midline shift. Intervals are normal in size. The extracranial structures are unremarkable in appearance. IMPRESSION: 1. Moderate size region of acute ischemia right cerebellar hemisphere with associated mild increased FLAIR, T2 signal, no MRI changes for petechial hemorrhage at this time. 2. Minimal white matter signal changes consistent with leukoaraiosis. Noncontrast brain MRI otherwise negative ECHO TRANSTHORACIC (TTE)May 3, 2021 Fasting Lipid (Cholesterol) Screening May 3, 2021 Cholesterol, Total, P 162 mg/dL mg/dL ----REFERENCE VALUE---- Desirable: < 200 Borderline high: 200 - 239 High: $g or = 240 Triglycerides, Fasting, P 137 mg/dL mg/dL ----REFERENCE VALUE---- Normal: <150 Borderline high: 150-199 High: 200-499 Very high: $g or =500 Cholesterol, HDL, P 33 mg/dL $g=40 mg/dL L Calculated LDL 102 mg/dL mg/dL ----REFERENCE VALUE---- Desirable: <100 Above Desirable: 100-129 Borderline high: 130-159 High: 160-189 Very high: $g or =190 Non HDL Cholesterol 129 mg/dL mg/dL ----REFERENCE VALUE---- Desirable: <130 Above Desirable: 130-159 Borderline high: 160-189 High: 190-219 Very high: $g or =220 Complete Blood Count May 3, 2021 Hemoglobin 13.8 g/dL 13.2 - 16.6 g/dL Hematocrit 40.1 % 38.3 - 48.6 % Erythrocytes 4.42 x10(12)/L 4.35 - 5.65 x10(12)/L MCV 90.7 fL 78.2 - 97.9 fL RBC Distrib Width 12.0 % 11.8 - 14.5 % Platelet Count 220 x10(9)/L 135 - 317 x10(9)/L Leukocytes 9.9 x10(9)/L 3.4 - 9.6 x10(9)/L H Neutrophils 6.74 x10(9)/L 1.56 - 6.45 x10(9)/L H Lymphocytes 2.21 x10(9)/L 0.95 - 3.07 x10(9)/L Monocytes 0.82 x10(9)/L 0.26 - 0.81 x10(9)/L H Eosinophils 0.09 x10(9)/L 0.03 - 0.48 x10(9)/L Basophils 0.05 x10(9)/L 0.01 - 0.08 x10(9)/L Hemoglobin A1C (Average Blood Sugar)May 3, 2021 Hemoglobin A1c, B 5.8 % SARS Coronavirus 2, PCR Rapid, V May 2, 2021 undetected SARS Coronavirus 2, PCR, V May 2, 2021 undetected CT HEAD NECK ANGIOGRAM WITH IV CONTRAST May 2, 2021 EXAM: CT HEAD NECK ANGIOGRAM WITH IV CONTRAST Including 3-D image postprocessing. COMPARISON: CT May 2, 2021. FINDINGS: Right carotid system: Normal. Left carotid system: Normal. Vertebral arteries: Normal. Left dominant. Aortic arch: Unremarkable. Intracranial: Anterior, middle and posterior cerebral arteries are well opacified with contrast. No evidence of a stenosis or aneurysm. Nonvascular findings: Focal loss of gray-white matter differentiation in the right cerebellar hemisphere as well as a chronic right cerebellar lacunar infarct. Measurement of a carotid stenosis, if present, is based on length parameters that compare the residual internal carotid luminal diameter with that of the normal distal ICA in accordance with North American Symptomatic Carotid Endarterectomy Trial (NASCET). IMPRESSION: 1. There is now evidence of focal loss of gray-white matter differentiation in the right cerebellar hemisphere, likely related to acute infarct. 2. Negative CT angiogram of the head and neck. TROPONIN T, 2H/6H, P May 2, 2021 Troponin T, 2 hr, 5th gen 7 ng/L <=15 ng/L Biotin has been identified by the manufacturer as a potential interfering substance. Higher concentrations of biotin may be found in multivitamins, hair/nail supplements, and workout supplements. If the result does not match clinical observations, repeat testing after patient refrains from the use of supplements for at least 12 hours. 2H Delta 0 ng/L ng/L 2H Delta Interp Not Changing Troponin T, 6 hr, 5th gen CANCELED ng/L ng/L CT HEAD WITHOUT IV CONTRAST May 2, 2021 FINDINGS: There is no evidence of acute intracranial hemorrhage. There is no intracranial mass. There is no midline shift. Ventricles and sulci appear within normal limits. There is no evidence of acute infarction. IMPRESSION: No acute findings or evidence of an intracranial mass. Complete Blood Count May 2, 2021 Hemoglobin 14.8 g/dL 13.2 - 16.6 g/dL Hematocrit 43.2 % 38.3 - 48.6 % Erythrocytes 4.88 x10(12)/L 4.35 - 5.65 x10(12)/L MCV 88.5 fL 78.2 - 97.9 fL RBC Distrib Width 11.9 % 11.8 - 14.5 % Platelet Count 240 x10(9)/L 135 - 317 x10(9)/L Leukocytes 11.3 x10(9)/L 3.4 - 9.6 x10(9)/L H Neutrophils 9.70 x10(9)/L 1.56 - 6.45 x10(9)/L H Lymphocytes 0.96 x10(9)/L 0.95 - 3.07 x10(9)/L Monocytes 0.55 x10(9)/L 0.26 - 0.81 x10(9)/L Eosinophils <0.03 x10(9)/L 0.03 - 0.48 x10(9)/L Basophils 0.05 x10(9)/L 0.01 - 0.08 x10(9)/L Extended Metabolic/Electrolyte panel May 2, 2021 Potassium, P 3.9 mmol/L 3.6 - 5.2 mmol/L Sodium, P 141 mmol/L 135 - 145 mmol/L Chloride, P 105 mmol/L 98 - 107 mmol/L Bicarbonate, P 25 mmol/L 22 - 29 mmol/L Anion Gap, P 11 7 - 15 BUN, P 15 mg/dL 8 - 24 mg/dL Creatinine, P 1.26 mg/dL 0.74 - 1.35 mg/dL eGFR Black 72 mL/min/BSA $g=60 mL/min/BSA ----ADDITIONAL INFORMATION---- Estimated GFR calculated using the 2009 CKD_EPI creatinine equation. eGFR Non-Black 62 mL/min/BSA $g=60 mL/min/BSA ----ADDITIONAL INFORMATION---- Estimated GFR calculated using the 2009 CKD_EPI creatinine equation. Calcium, Total, P 9.8 mg/dL 8.6 - 10.0 mg/dL Glucose, P 170 mg/dL 70 - 140 mg/dL H Protein, Total, P 6.9 g/dL 6.3 - 7.9 g/dL Albumin, P 4.2 g/dL 3.5 - 5.0 g/dL Aspartate Aminotransferase (AST), P 28 U/L 8 - 48 U/L Alkaline Phosphatase, P 79 U/L 40 - 129 U/L Alanine Aminotransferase (ALT), P 27 U/L 7 - 55 U/L Bilirubin, Total, P 1.0 mg/dL <=1.2 mg/dL TROPONIN T, BASELINE, 5TH GEN, P May 2, 2021 Troponin T, Baseline, 5th gen 7 ng/L <=15 ng/L Magnesium Level May 2, 2021 Magnesium, P 2.0 mg/dL 1.7 - 2.3 mg/dL SALICYLATE LEVEL May 2, 2021 Salicylate, P <0.3 mg/dL <30.0 mg/dL ECG May 2, 2021 Ventricular Rate ECG/Min 66 BPM BPM PR Interval 198 ms ms QRSD Interval 86 ms ms QT Interval 418 ms ms QTC Interval 438 ms ms P Axis 35 degrees degrees R Axis 45 degrees degrees T Wave Axis 29 degrees degrees
CDC 'Split Type':

Write-up: stroke on 5/2 8:45 am hospitalized 5 days no physiologiical explanation. 3/4 of right cerebellum is dead. at onset nausea vomiting vision loss, loss of balance and coordination BP bottomed out low heartrate while sleepiing

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