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This is VAERS ID 904385

History of Changes from the VAERS Wayback Machine

First Appeared on 12/24/2020

VAERS ID: 904385
VAERS Form:2
Age:83.0
Sex:Female
Location:Texas
Vaccinated:2020-12-16
Onset:2020-12-16
Submitted:0000-00-00
Entered:2020-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Epistaxis, Facial bones fracture, Loss of consciousness, Subcutaneous haematoma, Tenderness, Comminuted fracture, Haemorrhage

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine, 7.5 mg, oral, Nightly ? cevimeline, 30 mg, oral, TID ? cholecalciferol (vitamin D3), 2,000 Units, oral, Daily ? irbesartan-hydrochlorothiazide, 1 tablet, oral, QAM ? levothyroxine, 50 mcg, oral, Daily at 0600 ? metoprolol s
Current Illness: None
Preexisting Conditions: Sjogrens Syndrome, Hypertension, Hypothyroidism
Allergies: Quinilones, Sulfa
Diagnostic Lab Data: There is a comminuted fracture of the nasal bones bilaterally with Left orbital floor blowout fracture with hemorrhagic opacification of the left maxillary sinus and slight inferior displacement with slight extraconal fat protrusion. There is associated left orbital preseptal and postseptal emphysema. Comminuted fracture involving the anterior and posterior wall of the left maxillary sinus with hemorrhagic opacification of the sinus and left malar subcutaneous hematoma
CDC 'Split Type':

Write-up: Patient is a pleasant 83 y.o. female pediatrician with history of Sjogren''s, hypothyroidism, hyperlipidemia, hypertension who had been at Hospital to get her Covid vaccine. 30 minutes after doing so she reports being in the lobby and about to walk upstairs and feeling fine. The next thing she knows she wakes up on the stairs with her nose and face bleeding surrounded by healthcare team. She denies any precipitating symptoms such as chest pain, shortness of breath, fevers dizziness, headache. She reports feeling well otherwise in the last few days. I did a thorough bony palpation exam including spine and he only point of tenderness besides on her face was the area above her right ankle. She does not have a history of syncope or collapse


Changed on 12/30/2020

VAERS ID: 904385 Before After
VAERS Form:2
Age:83.0
Sex:Female
Location:Texas
Vaccinated:2020-12-16
Onset:2020-12-16
Submitted:0000-00-00
Entered:2020-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Epistaxis, Facial bones fracture, Loss of consciousness, Subcutaneous haematoma, Tenderness, Comminuted fracture, Haemorrhage

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine, 7.5 mg, oral, Nightly ? cevimeline, 30 mg, oral, TID ? cholecalciferol (vitamin D3), 2,000 Units, oral, Daily ? irbesartan-hydrochlorothiazide, 1 tablet, oral, QAM ? levothyroxine, 50 mcg, oral, Daily at 0600 ? metoprolol s
Current Illness: None
Preexisting Conditions: Sjogrens Syndrome, Hypertension, Hypothyroidism
Allergies: Quinilones, Sulfa Sulfa
Diagnostic Lab Data: There is a comminuted fracture of the nasal bones bilaterally with Left orbital floor blowout fracture with hemorrhagic opacification of the left maxillary sinus and slight inferior displacement with slight extraconal fat protrusion. There is associated left orbital preseptal and postseptal emphysema. Comminuted fracture involving the anterior and posterior wall of the left maxillary sinus with hemorrhagic opacification of the sinus and left malar subcutaneous hematoma
CDC 'Split Type':

Write-up: Patient is a pleasant 83 y.o. female pediatrician with history of Sjogren''s, hypothyroidism, hyperlipidemia, hypertension who had been at Hospital to get her Covid vaccine. 30 minutes after doing so she reports being in the lobby and about to walk upstairs and feeling fine. The next thing she knows she wakes up on the stairs with her nose and face bleeding surrounded by healthcare team. She denies any precipitating symptoms such as chest pain, shortness of breath, fevers dizziness, headache. She reports feeling well otherwise in the last few days. I did a thorough bony palpation exam including spine and he only point of tenderness besides on her face was the area above her right ankle. She does not have a history of syncope or collapse


Changed on 5/7/2021

VAERS ID: 904385 Before After
VAERS Form:2
Age:83.0
Sex:Female
Location:Texas
Vaccinated:2020-12-16
Onset:2020-12-16
Submitted:0000-00-00
Entered:2020-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Epistaxis, Facial bones fracture, Loss of consciousness, Subcutaneous haematoma, Tenderness, Comminuted fracture, Haemorrhage

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine, 7.5 mg, oral, Nightly ? cevimeline, 30 mg, oral, TID ? cholecalciferol (vitamin D3), 2,000 Units, oral, Daily ? irbesartan-hydrochlorothiazide, 1 tablet, oral, QAM ? levothyroxine, 50 mcg, oral, Daily at 0600 ? metoprolol s
Current Illness: None
Preexisting Conditions: Sjogrens Syndrome, Hypertension, Hypothyroidism
Allergies: Quinilones, Sulfa Sulfa
Diagnostic Lab Data: There is a comminuted fracture of the nasal bones bilaterally with Left orbital floor blowout fracture with hemorrhagic opacification of the left maxillary sinus and slight inferior displacement with slight extraconal fat protrusion. There is associated left orbital preseptal and postseptal emphysema. Comminuted fracture involving the anterior and posterior wall of the left maxillary sinus with hemorrhagic opacification of the sinus and left malar subcutaneous hematoma
CDC 'Split Type':

Write-up: Patient is a pleasant 83 y.o. female pediatrician with history of Sjogren''s, hypothyroidism, hyperlipidemia, hypertension who had been at Hospital to get her Covid vaccine. 30 minutes after doing so she reports being in the lobby and about to walk upstairs and feeling fine. The next thing she knows she wakes up on the stairs with her nose and face bleeding surrounded by healthcare team. She denies any precipitating symptoms such as chest pain, shortness of breath, fevers dizziness, headache. She reports feeling well otherwise in the last few days. I did a thorough bony palpation exam including spine and he only point of tenderness besides on her face was the area above her right ankle. She does not have a history of syncope or collapse


Changed on 5/14/2021

VAERS ID: 904385 Before After
VAERS Form:2
Age:83.0
Sex:Female
Location:Texas
Vaccinated:2020-12-16
Onset:2020-12-16
Submitted:0000-00-00
Entered:2020-12-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 AR / IM

Administered by: Private      Purchased by: ??
Symptoms: Epistaxis, Facial bones fracture, Loss of consciousness, Subcutaneous haematoma, Tenderness, Comminuted fracture, Haemorrhage

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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine, 7.5 mg, oral, Nightly ? cevimeline, 30 mg, oral, TID ? cholecalciferol (vitamin D3), 2,000 Units, oral, Daily ? irbesartan-hydrochlorothiazide, 1 tablet, oral, QAM ? levothyroxine, 50 mcg, oral, Daily at 0600 ? metoprolol s
Current Illness: None
Preexisting Conditions: Sjogrens Syndrome, Hypertension, Hypothyroidism
Allergies: Quinilones, Sulfa Sulfa
Diagnostic Lab Data: There is a comminuted fracture of the nasal bones bilaterally with Left orbital floor blowout fracture with hemorrhagic opacification of the left maxillary sinus and slight inferior displacement with slight extraconal fat protrusion. There is associated left orbital preseptal and postseptal emphysema. Comminuted fracture involving the anterior and posterior wall of the left maxillary sinus with hemorrhagic opacification of the sinus and left malar subcutaneous hematoma
CDC 'Split Type':

Write-up: Patient is a pleasant 83 y.o. female pediatrician with history of Sjogren''s, hypothyroidism, hyperlipidemia, hypertension who had been at Hospital to get her Covid vaccine. 30 minutes after doing so she reports being in the lobby and about to walk upstairs and feeling fine. The next thing she knows she wakes up on the stairs with her nose and face bleeding surrounded by healthcare team. She denies any precipitating symptoms such as chest pain, shortness of breath, fevers dizziness, headache. She reports feeling well otherwise in the last few days. I did a thorough bony palpation exam including spine and he only point of tenderness besides on her face was the area above her right ankle. She does not have a history of syncope or collapse

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