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This is VAERS ID 1040844

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1040844
VAERS Form:2
Age:71.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-16
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Blood potassium decreased, Blood pressure fluctuation, Blood sodium decreased, Chest pain, Computerised tomogram normal, CSF protein increased, Echocardiogram normal, Electrocardiogram normal, Electroencephalogram normal, Gait inability, Guillain-Barre syndrome, Hypoaesthesia, Injection site pain, Lumbar puncture, Muscular weakness, Paraesthesia, Dysstasia, Blood test normal, Fine motor skill dysfunction, Magnetic resonance imaging normal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril 40 mg tablet Hydrochlorothiazide 25 mg tablet asprin 81 mg Glucosamine JCL 1500 with MSM 600+D3 Calcium a
Current Illness: None
Preexisting Conditions: Elevated BP - Nothing else
Allergies: None
Diagnostic Lab Data: 1/30-2/2 - EKG, Between 2/2 - 2/12 - Echocardiogram, 2 C Scans, MRI, multiple Blood tests - all were negative but his Sodium and Potassium level were very low, particularly the sodium level. Given IV treatment for that. 2/15 - EEG - Negative, Spinal Tap - Protein level I believe was 113. Diagnosed Guillain Barre Syndrome -
CDC 'Split Type':

Write-up: 1/30/2021 Began with spiking BP and extreme pain in right shoulder - taken to ER. Given pain med, BP came down and sent home. 2/2/2021 - Spiking BP and chest pain, numbness and tingling in hands and feet. - taken to Medical Center. Admitted. Series of heart and brain assessments done. Each day he got weaker until he could no longer stand, walk, arm and hand strength depleted and dexterity issues. Spinal Tap on 2/8/2021 revealed Guillain Barre Syndrome 2/12 Admitted to Rehabilitation Center, 2/15 at Hospital plummeting BP, 2/18 return to Rehabilitation Center


Changed on 5/7/2021

VAERS ID: 1040844 Before After
VAERS Form:2
Age:71.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-16
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Blood potassium decreased, Blood pressure fluctuation, Blood sodium decreased, Chest pain, Computerised tomogram normal, CSF protein increased, Echocardiogram normal, Electrocardiogram normal, Electroencephalogram normal, Gait inability, Guillain-Barre syndrome, Hypoaesthesia, Injection site pain, Lumbar puncture, Muscular weakness, Paraesthesia, Dysstasia, Blood test normal, Fine motor skill dysfunction, Magnetic resonance imaging normal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril 40 mg tablet Hydrochlorothiazide 25 mg tablet asprin 81 mg Glucosamine JCL 1500 with MSM 600+D3 Calcium a
Current Illness: None
Preexisting Conditions: Elevated BP - Nothing else
Allergies: None None
Diagnostic Lab Data: 1/30-2/2 - EKG, Between 2/2 - 2/12 - Echocardiogram, 2 C Scans, MRI, multiple Blood tests - all were negative but his Sodium and Potassium level were very low, particularly the sodium level. Given IV treatment for that. 2/15 - EEG - Negative, Spinal Tap - Protein level I believe was 113. Diagnosed Guillain Barre Syndrome -
CDC 'Split Type':

Write-up: 1/30/2021 Began with spiking BP and extreme pain in right shoulder - taken to ER. Given pain med, BP came down and sent home. 2/2/2021 - Spiking BP and chest pain, numbness and tingling in hands and feet. - taken to Medical Center. Admitted. Series of heart and brain assessments done. Each day he got weaker until he could no longer stand, walk, arm and hand strength depleted and dexterity issues. Spinal Tap on 2/8/2021 revealed Guillain Barre Syndrome 2/12 Admitted to Rehabilitation Center, 2/15 at Hospital plummeting BP, 2/18 return to Rehabilitation Center


Changed on 5/14/2021

VAERS ID: 1040844 Before After
VAERS Form:2
Age:71.0
Sex:Male
Location:Ohio
Vaccinated:2021-01-16
Onset:2021-01-30
Submitted:0000-00-00
Entered:2021-02-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EL3249 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Asthenia, Blood potassium decreased, Blood pressure fluctuation, Blood sodium decreased, Chest pain, Computerised tomogram normal, CSF protein increased, Echocardiogram normal, Electrocardiogram normal, Electroencephalogram normal, Gait inability, Guillain-Barre syndrome, Hypoaesthesia, Injection site pain, Lumbar puncture, Muscular weakness, Paraesthesia, Dysstasia, Blood test normal, Fine motor skill dysfunction, Magnetic resonance imaging normal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 11     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril 40 mg tablet Hydrochlorothiazide 25 mg tablet asprin 81 mg Glucosamine JCL 1500 with MSM 600+D3 Calcium a
Current Illness: None
Preexisting Conditions: Elevated BP - Nothing else
Allergies: None None
Diagnostic Lab Data: 1/30-2/2 - EKG, Between 2/2 - 2/12 - Echocardiogram, 2 C Scans, MRI, multiple Blood tests - all were negative but his Sodium and Potassium level were very low, particularly the sodium level. Given IV treatment for that. 2/15 - EEG - Negative, Spinal Tap - Protein level I believe was 113. Diagnosed Guillain Barre Syndrome -
CDC 'Split Type':

Write-up: 1/30/2021 Began with spiking BP and extreme pain in right shoulder - taken to ER. Given pain med, BP came down and sent home. 2/2/2021 - Spiking BP and chest pain, numbness and tingling in hands and feet. - taken to Medical Center. Admitted. Series of heart and brain assessments done. Each day he got weaker until he could no longer stand, walk, arm and hand strength depleted and dexterity issues. Spinal Tap on 2/8/2021 revealed Guillain Barre Syndrome 2/12 Admitted to Rehabilitation Center, 2/15 at Hospital plummeting BP, 2/18 return to Rehabilitation Center

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