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This is VAERS ID 1033614

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1033614
VAERS Form:2
Age:42.0
Sex:Female
Location:Florida
Vaccinated:2021-01-15
Onset:2021-01-22
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: Cauda equina syndrome, CSF protein increased, Gait disturbance, Guillain-Barre syndrome, Injection site erythema, Injection site reaction, Injection site warmth, Lumbar puncture abnormal, Paraesthesia, Peripheral motor neuropathy, Peripheral sensory neuropathy, Plasmapheresis, Protein total increased, Pruritus, White blood cell count decreased, CSF white blood cell count negative, Computerised tomogram head normal, Autoimmune demyelinating disease, Magnetic resonance imaging brain normal, Magnetic resonance imaging spinal abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? 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.


Changed on 5/7/2021

VAERS ID: 1033614 Before After
VAERS Form:2
Age:42.0
Sex:Female
Location:Florida
Vaccinated:2021-01-15
Onset:2021-01-22
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: Cauda equina syndrome, CSF protein increased, Gait disturbance, Guillain-Barre syndrome, Injection site erythema, Injection site reaction, Injection site warmth, Lumbar puncture abnormal, Paraesthesia, Peripheral motor neuropathy, Peripheral sensory neuropathy, Plasmapheresis, Protein total increased, Pruritus, White blood cell count decreased, CSF white blood cell count negative, Computerised tomogram head normal, Autoimmune demyelinating disease, Magnetic resonance imaging brain normal, Magnetic resonance imaging spinal abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Sjogren''s syndrome, hypothyroidism, anemia
Allergies: Latex, tramadol 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.


Changed on 5/14/2021

VAERS ID: 1033614 Before After
VAERS Form:2
Age:42.0
Sex:Female
Location:Florida
Vaccinated:2021-01-15
Onset:2021-01-22
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: Cauda equina syndrome, CSF protein increased, Gait disturbance, Guillain-Barre syndrome, Injection site erythema, Injection site reaction, Injection site warmth, Lumbar puncture abnormal, Paraesthesia, Peripheral motor neuropathy, Peripheral sensory neuropathy, Plasmapheresis, Protein total increased, Pruritus, White blood cell count decreased, CSF white blood cell count negative, Computerised tomogram head normal, Autoimmune demyelinating disease, Magnetic resonance imaging brain normal, Magnetic resonance imaging spinal abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Sjogren''s syndrome, hypothyroidism, anemia
Allergies: Latex, tramadol 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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