VAERS ID: 1818349

AGE: 85| SEX: M|STATE: CT (United States)

Description

Vaccination received on 10/21/21. On 10/24 resident developed sudden change in mental status with hypertensive crisis requiring transfer to the Emergency Department.

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Symptoms

Hypertensive crisis, Mental status changes, Computerised tomogram head abnormal, Brain stem haemorrhage, Congenital cerebrovascular anomaly

Vaccines

VAX DATE: 10-21-2021| ONSET DATE: 10-24-2021| DAYS TO ONSET: 3
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 3 COVID19 PFIZER\BIONTECH FH8027 IM LA

RECVDATE:10-26-2021
RPT_DATE:
CAGE_YR:85
CAGE_MO:
DIED:Y
DATEDIED:10-25-2021
L_THREAT:U
ER_VISIT:
HOSPITAL:U
HOSPDAYS:
X_STAY:U
DISABLE:U
RECOVD:N
LAB_DATA:Ct Scan revealed Vascular malformation in the central pons with acute hemorrhage.
V_ADMINBY:SEN
OTHER_MEDS:tylenol 650 mg PRN Artificial tears prn bid Bengay patch PRN to back and neck bisacodyl 10 mg prn vit d3 50,000 units q monday depakote 250 qhs depakote 125 mg qam finasteride 5 mg q daily fluoromethalone eye drops 0.1 % qhs Hydroxyzine 2
CUR_ILL:no acute illnes at this time.
HISTORY:Adjustment disorder with mixed anxiety and depressed mood F43.23 10/14/2020 Active ICD-10 Other specified depressive episodes F32.89 10/12/2020 Active ICD-10 Unspecified fracture of left femur, subsequent encounter for closed fracture with routine healing S72.92XD 05/04/2020 Active ICD-10 Other spondylosis with radiculopathy, cervical region M47.22 05/04/2020 Active ICD-10 Postpolio syndrome G14 05/04/2020 Active ICD-10 Unspecified fall, subsequent encounter W19.XXXD 05/04/2020 Active ICD-10 Difficulty in walking, not elsewhere classified R26.2 05/04/2020 Active ICD-10 Muscle weakness (generalized) M62.81 05/04/2020 Active ICD-10 Generalized anxiety disorder F41.1 05/04/2020 Active ICD-10 Lactose intolerance, unspecified E73.9 05/04/2020 Active ICD-10 Mixed irritable bowel syndrome K58.2 05/04/2020 Active ICD-10 Benign prostatic hyperplasia without lower urinary tract symptoms N40.0 05/04/2020 Active ICD-10 Mild cognitive impairment, so stated
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:10-26-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:Prednisone
V_FUNDBY:

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