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This is VAERS ID 1049819

History of Changes from the VAERS Wayback Machine

First Appeared on 2/26/2021

VAERS ID: 1049819
VAERS Form:2
Age:56.0
Sex:Male
Location:California
Vaccinated:2021-01-20
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 LA / -

Administered by: Other      Purchased by: ??
Symptoms: CSF protein increased, Gait inability, Guillain-Barre syndrome, Muscular weakness, Vitamin B12 deficiency, Immunoglobulin therapy, Vertebral foraminal stenosis, Magnetic resonance imaging spinal abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen 325 mg Tab (Tylenol) 650 mg 2 tab Oral TID PRN: pain capsaicin 0.025% Cream 60 gm (capsaicin 0.025% topical cream) 1 app Topical Daily cholecalciferol 2,000 unit Cap (Vitamin D3) 2,000 unit 1 cap Oral Daily clotrimaz
Current Illness: DM HTN Chronic kidney disease
Preexisting Conditions: DM HTN Chronic kidney disease
Allergies: Penicillin
Diagnostic Lab Data: CSF analysis, showed elevation of serum protein MRI of Lumbar spine showed mild to moderate neural foraminal stenosis. Vitamin B12 was also reported deficient.
CDC 'Split Type':

Write-up: Patient developed lower extremity weakness, the weakness progressed and after few days he was not able to walk even with help of crutches. Guillain barre syndrome was suspected. He was sent to hospital. Lumbar puncture was performed on him showed elevation of CSF protein. He received IVIG and his weakness improved. He also received Vitamin B12 injection due to Vitamin B12 deficiency


Changed on 5/7/2021

VAERS ID: 1049819 Before After
VAERS Form:2
Age:56.0
Sex:Male
Location:California
Vaccinated:2021-01-20
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 LA / -

Administered by: Other      Purchased by: ??
Symptoms: CSF protein increased, Gait inability, Guillain-Barre syndrome, Muscular weakness, Vitamin B12 deficiency, Immunoglobulin therapy, Vertebral foraminal stenosis, Magnetic resonance imaging spinal abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen 325 mg Tab (Tylenol) 650 mg 2 tab Oral TID PRN: pain capsaicin 0.025% Cream 60 gm (capsaicin 0.025% topical cream) 1 app Topical Daily cholecalciferol 2,000 unit Cap (Vitamin D3) 2,000 unit 1 cap Oral Daily clotrimaz
Current Illness: DM HTN Chronic kidney disease
Preexisting Conditions: DM HTN Chronic kidney disease
Allergies: Penicillin Penicillin
Diagnostic Lab Data: CSF analysis, showed elevation of serum protein MRI of Lumbar spine showed mild to moderate neural foraminal stenosis. Vitamin B12 was also reported deficient.
CDC 'Split Type':

Write-up: Patient developed lower extremity weakness, the weakness progressed and after few days he was not able to walk even with help of crutches. Guillain barre syndrome was suspected. He was sent to hospital. Lumbar puncture was performed on him showed elevation of CSF protein. He received IVIG and his weakness improved. He also received Vitamin B12 injection due to Vitamin B12 deficiency


Changed on 5/14/2021

VAERS ID: 1049819 Before After
VAERS Form:2
Age:56.0
Sex:Male
Location:California
Vaccinated:2021-01-20
Onset:2021-01-21
Submitted:0000-00-00
Entered:2021-02-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA 029L20A / 1 LA / -

Administered by: Other      Purchased by: ??
Symptoms: CSF protein increased, Gait inability, Guillain-Barre syndrome, Muscular weakness, Vitamin B12 deficiency, Immunoglobulin therapy, Vertebral foraminal stenosis, Magnetic resonance imaging spinal abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: acetaminophen 325 mg Tab (Tylenol) 650 mg 2 tab Oral TID PRN: pain capsaicin 0.025% Cream 60 gm (capsaicin 0.025% topical cream) 1 app Topical Daily cholecalciferol 2,000 unit Cap (Vitamin D3) 2,000 unit 1 cap Oral Daily clotrimaz
Current Illness: DM HTN Chronic kidney disease
Preexisting Conditions: DM HTN Chronic kidney disease
Allergies: Penicillin Penicillin
Diagnostic Lab Data: CSF analysis, showed elevation of serum protein MRI of Lumbar spine showed mild to moderate neural foraminal stenosis. Vitamin B12 was also reported deficient.
CDC 'Split Type':

Write-up: Patient developed lower extremity weakness, the weakness progressed and after few days he was not able to walk even with help of crutches. Guillain barre syndrome was suspected. He was sent to hospital. Lumbar puncture was performed on him showed elevation of CSF protein. He received IVIG and his weakness improved. He also received Vitamin B12 injection due to Vitamin B12 deficiency

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