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This is VAERS ID 973957

History of Changes from the VAERS Wayback Machine

First Appeared on 1/29/2021

VAERS ID: 973957
VAERS Form:2
Age:81.0
Sex:Male
Location:North Carolina
Vaccinated:2021-01-20
Onset:2021-01-24
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Activated partial thromboplastin time shortened, Blood pressure increased, Death, International normalised ratio increased, Platelet count normal, Prothrombin time prolonged, Subarachnoid haemorrhage, Subdural haemorrhage, Computerised tomogram head abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-26
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: pantoprazole 40 mg daily potassium chloride 10 meq daily sotalol 120mg BID warfarin 2.5mg daily warfarin 5mg weekly furosemide 40mg daily allopurinol 200 mg daily donepezil 10mg daily lisinopril 5mg daily
Current Illness: none
Preexisting Conditions: atrial fibrillation, hypertension, GERD, prostate cancer
Allergies: penicillin
Diagnostic Lab Data: PT 36.0 PTT 39.0 INR 3.1 platelets 195 Head CT - Large Geographic left parietal/occipital parenchymal hemorrhage with 12mm rightward shift. Subarachnoid and subdural hemorrhage of the left hemisphere.
CDC 'Split Type':

Write-up: 5 days after receiving his COVID vaccination the patient had a spontaneous (nontraumatic) subarachnoid hemorrhage which was fatal. The patient had previously been stable on his coumadin dosing with therapeutic INRs for the past several months per his wife. At time of presentation his blood pressure in the ER was elevated to 223/94 and his INR was risen to 3.1


Changed on 5/7/2021

VAERS ID: 973957 Before After
VAERS Form:2
Age:81.0
Sex:Male
Location:North Carolina
Vaccinated:2021-01-20
Onset:2021-01-24
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Activated partial thromboplastin time shortened, Blood pressure increased, Death, International normalised ratio increased, Platelet count normal, Prothrombin time prolonged, Subarachnoid haemorrhage, Subdural haemorrhage, Computerised tomogram head abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-26
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: pantoprazole 40 mg daily potassium chloride 10 meq daily sotalol 120mg BID warfarin 2.5mg daily warfarin 5mg weekly furosemide 40mg daily allopurinol 200 mg daily donepezil 10mg daily lisinopril 5mg daily
Current Illness: none
Preexisting Conditions: atrial fibrillation, hypertension, GERD, prostate cancer
Allergies: penicillin penicillin
Diagnostic Lab Data: PT 36.0 PTT 39.0 INR 3.1 platelets 195 Head CT - Large Geographic left parietal/occipital parenchymal hemorrhage with 12mm rightward shift. Subarachnoid and subdural hemorrhage of the left hemisphere.
CDC 'Split Type':

Write-up: 5 days after receiving his COVID vaccination the patient had a spontaneous (nontraumatic) subarachnoid hemorrhage which was fatal. The patient had previously been stable on his coumadin dosing with therapeutic INRs for the past several months per his wife. At time of presentation his blood pressure in the ER was elevated to 223/94 and his INR was risen to 3.1


Changed on 5/14/2021

VAERS ID: 973957 Before After
VAERS Form:2
Age:81.0
Sex:Male
Location:North Carolina
Vaccinated:2021-01-20
Onset:2021-01-24
Submitted:0000-00-00
Entered:2021-01-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Activated partial thromboplastin time shortened, Blood pressure increased, Death, International normalised ratio increased, Platelet count normal, Prothrombin time prolonged, Subarachnoid haemorrhage, Subdural haemorrhage, Computerised tomogram head abnormal

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-01-26
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: pantoprazole 40 mg daily potassium chloride 10 meq daily sotalol 120mg BID warfarin 2.5mg daily warfarin 5mg weekly furosemide 40mg daily allopurinol 200 mg daily donepezil 10mg daily lisinopril 5mg daily
Current Illness: none
Preexisting Conditions: atrial fibrillation, hypertension, GERD, prostate cancer
Allergies: penicillin penicillin
Diagnostic Lab Data: PT 36.0 PTT 39.0 INR 3.1 platelets 195 Head CT - Large Geographic left parietal/occipital parenchymal hemorrhage with 12mm rightward shift. Subarachnoid and subdural hemorrhage of the left hemisphere.
CDC 'Split Type':

Write-up: 5 days after receiving his COVID vaccination the patient had a spontaneous (nontraumatic) subarachnoid hemorrhage which was fatal. The patient had previously been stable on his coumadin dosing with therapeutic INRs for the past several months per his wife. At time of presentation his blood pressure in the ER was elevated to 223/94 and his INR was risen to 3.1

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