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VAERS ID: | 938118 |
VAERS Form: | 2 |
Age: | 51.0 |
Sex: | Female |
Location: | Michigan |
Vaccinated: | 2021-01-05 |
Onset: | 2021-01-08 |
Submitted: | 0000-00-00 |
Entered: | 2021-01-12 |
Vaccination / Manufacturer (1 vaccine) | Lot / Dose | Site / Route |
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH | EK9231 / 1 | - / IM |
Administered by: Public Purchased by: ??
Symptoms: Aneurysm, Arteriogram carotid, Cerebellar haemorrhage, Cerebrovascular accident, Chest X-ray, Angiogram cerebral, Computerised tomogram thorax, Computerised tomogram abdomen, Computerised tomogram head, Abdominal X-ray, Computerised tomogram pelvis, Computerised tomogram spine
Life Threatening? Yes
Birth Defect? No
Died? Yes
Date died:2021-01-10
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 2
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
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