| VAERS ID: |
938118 (history) |
| Form: |
Version 2.0 |
| Age: |
51.0 |
| Sex: |
Female |
| Location: |
Michigan |
| Vaccinated: | 2021-01-05 |
| Onset: | 2021-01-08 |
| Days after vaccination: | 3 |
| Submitted: |
0000-00-00 |
| Entered: |
2021-01-12 |
| Vaccination / Manufacturer |
Lot / Dose |
Site / Route |
| COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH |
EK9231 / 1 |
- / IM |
Administered by: Public Purchased by: ?
Symptoms: Abdominal X-ray,
Aneurysm,
Angiogram cerebral,
Arteriogram carotid,
Cerebellar haemorrhage,
Cerebrovascular accident,
Chest X-ray,
Computerised tomogram abdomen,
Computerised tomogram head,
Computerised tomogram pelvis,
Computerised tomogram spine,
Computerised tomogram thorax
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Ischaemic central nervous system vascular conditions (narrow), Haemorrhagic central nervous system vascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow)
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died: 2021-01-10
Days after onset: 2
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
Extended hospital stay? No
Previous Vaccinations:
Other Medications: multivitamin; vitamin D
Current Illness: none mentioned
Preexisting Conditions: no significant past medical history
Allergies: latex
Diagnostic Lab Data: CT brain head; CT cervical spine; chest xray; CT chest, abdomen, pelvis; abdominal xray; CT angiogram neck & brain
CDC Split Type:
Write-up: on 1/8/2021 17:30 patient taken to ER, cerebellar hemorrhage, stroke, aneurysm |
