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This is VAERS ID 1714939

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/24/2021

VAERS ID: 1714939
VAERS Form:2
Age:56.0
Sex:Male
Location:Maine
Vaccinated:2021-09-11
Onset:2021-09-14
Submitted:0000-00-00
Entered:2021-09-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Hemiparesis, Vertebral artery occlusion, Angiogram cerebral abnormal, Anticoagulant therapy, Cerebral arteriosclerosis

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: smokes cigarettes
Current Illness: none known
Preexisting Conditions: None
Allergies: none
Diagnostic Lab Data: IMPRESSION: (CTA) 1. Occlusion or dissection of the right vertebral artery shortly after the origin with reconstitution of the cervical V3 segment at the C2 level. There is asymmetric diminished attenuation of the V4 segment. 2. Left posterior cerebral artery P1 segment moderate atherosclerotic disease.
CDC 'Split Type':

Write-up: Patient woke with left hemiparesis went to the emergency room at Hospital. patient received IV heparin with resolution of hemiparesis. Medical records show that patient was advised hospitalization is stroke center declined and left against medical advice. On my evaluation on September 20, 2021 there have been no recurrence of symptoms

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