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From the 6/11/2021 release of VAERS data:

This is VAERS ID 1033614



Case Details

VAERS ID: 1033614 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-01-15
Onset:2021-01-22
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 039K20A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Autoimmune demyelinating disease, CSF protein increased, CSF white blood cell count negative, Cauda equina syndrome, Computerised tomogram head normal, Gait disturbance, Guillain-Barre syndrome, Injection site erythema, Injection site reaction, Injection site warmth, Lumbar puncture abnormal, Magnetic resonance imaging brain normal, Magnetic resonance imaging spinal abnormal, Paraesthesia, Peripheral motor neuropathy, Peripheral sensory neuropathy, Plasmapheresis, Protein total increased, Pruritus, White blood cell count decreased
SMQs:, Anaphylactic reaction (broad), Haematopoietic leukopenia (narrow), Peripheral neuropathy (narrow), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (narrow), Extravasation events (injections, infusions and implants) (broad), Optic nerve disorders (broad), Demyelination (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Sjogren''s syndrome, hypothyroidism, anemia
Allergies: Latex, tramadol
Diagnostic Lab Data: CT head without contrast 2/10/21: no acute intracranial abn MRI L-spine 2/12/21: Mild diffuse enhancement of the cauda equina nerve roots, which may be seen with Gillian Barre syndro MRI brain demyelinating disease 2/12/21: No acute intracranial abnormality. No abnormal parenchymal enhancement. No evidence of acute/subacute ischemia LP 2/11/21: cytoalbuminologic dissociation (75 protein, 3 WBC)
CDC Split Type:

Write-up: Patient received first Moderna vaccine on 1/15/2021. Delayed injection site reaction which was warm and erythematous 1 week after vaccination on left arm for which was seen by PCP and prescribed Bactrim for 10 days. On 2/3/21 patient experienced itchiness in hands and feet with pins and needles sensation. Seen by PCP on 2/4/21 and was started on Medrol Dose Pack for pruritis and paresthesias. 2/10/21 presented to ED with progressive sensory motor polyneuropathy and early gait dysfunction. Patient started plasmapharesis treatment for suspected Guillan-Barre Syndrome on 2/11/2021.


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