National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1042915

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1042915
VAERS Form:2
Age:52.0
Sex:Male
Location:Florida
Vaccinated:2021-01-25
Onset:2021-02-10
Submitted:0000-00-00
Entered:2021-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L26A / 2 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Autoimmune hepatitis, Guillain-Barre syndrome, Blood test, Immunoglobulin therapy, Magnetic resonance imaging

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Valtrex 500 BID, Benicar 40 QD, 81 ASAS QD, Vitamin Ds 15000U daily
Current Illness: None
Preexisting Conditions: HTN, alpha one antitrypsin carrier (MS phenotype)
Allergies: PCN
Diagnostic Lab Data: LP X 2, Contrasted ad un-contrasted MRI holo spine X 2, multiple blood tests
CDC 'Split Type':

Write-up: Guillain-Barr? syndrome. So far hospitalized =X 7 days, on day 3 of IV IG with ICC line, then planned 3 days of high dose soleumedrol, then plasmapheresis Auto-immune hepatitis


Changed on 5/7/2021

VAERS ID: 1042915 Before After
VAERS Form:2
Age:52.0
Sex:Male
Location:Florida
Vaccinated:2021-01-25
Onset:2021-02-10
Submitted:0000-00-00
Entered:2021-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L26A / 2 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Autoimmune hepatitis, Guillain-Barre syndrome, Blood test, Immunoglobulin therapy, Magnetic resonance imaging

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Valtrex 500 BID, Benicar 40 QD, 81 ASAS QD, Vitamin Ds 15000U daily
Current Illness: None
Preexisting Conditions: HTN, alpha one antitrypsin carrier (MS phenotype)
Allergies: PCN PCN
Diagnostic Lab Data: LP X 2, Contrasted ad un-contrasted MRI holo spine X 2, multiple blood tests
CDC 'Split Type':

Write-up: Guillain-Barr? Guillain-Barré syndrome. So far hospitalized =X 7 days, on day 3 of IV IG with ICC line, then planned 3 days of high dose soleumedrol, then plasmapheresis Auto-immune hepatitis


Changed on 5/14/2021

VAERS ID: 1042915 Before After
VAERS Form:2
Age:52.0
Sex:Male
Location:Florida
Vaccinated:2021-01-25
Onset:2021-02-10
Submitted:0000-00-00
Entered:2021-02-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 028L26A / 2 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Autoimmune hepatitis, Guillain-Barre syndrome, Blood test, Immunoglobulin therapy, Magnetic resonance imaging

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Valtrex 500 BID, Benicar 40 QD, 81 ASAS QD, Vitamin Ds 15000U daily
Current Illness: None
Preexisting Conditions: HTN, alpha one antitrypsin carrier (MS phenotype)
Allergies: PCN PCN
Diagnostic Lab Data: LP X 2, Contrasted ad un-contrasted MRI holo spine X 2, multiple blood tests
CDC 'Split Type':

Write-up: Guillain-Barré Guillain-Barr? syndrome. So far hospitalized =X 7 days, on day 3 of IV IG with ICC line, then planned 3 days of high dose soleumedrol, then plasmapheresis Auto-immune hepatitis

New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=1042915&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166