VAERS ID: 1772015

AGE: 15| SEX: M|STATE: NY (United States)

Description

Dose 1 given on 5/28/21 and dose 2 given on 6/22/2021. By report the patient developed weakness which progressed to ataxia over the ensuing 3 months. This was also associated with tinnitus. He was noted about 2 months after his second dose to have progression of symptoms with abnormal neurologic exam which prompted inpatient admission. MRI brain showed multifocal hemorrhagic lesions in the cerebral white matter, brainstem and cerebellum with greatest involvement in the left pons. Multifocal short segment enhancing lesions throughout the spinal cord. Patient was admitted for diagnostic work up and initiated on steroids with some symptomatic improvement when on hospital day 10 he had an acute event thought to be a stroke. CTA showed new areas of brainstem intraparenchymal hemorrhage including the dorsal right pons and right-sided cerebellar peduncles.

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Symptoms

Asthenia, Tinnitus, Cerebral haemorrhage, Cerebrovascular accident, Neurological examination abnormal, Computerised tomogram head, Central nervous system lesion, Ataxia, Angiogram abnormal, Computerised tomogram thorax, Computerised tomogram abdomen, Scan with contrast, Inappropriate schedule of product administration, White matter lesion, Magnetic resonance imaging spinal, Magnetic resonance imaging head abnormal, Brain stem haemorrhage

Vaccines

VAX DATE: 05-28-2021| ONSET DATE: 06-01-2021| DAYS TO ONSET: 4
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (PFIZER-BIONTECH)) 1 COVID19 PFIZER\BIONTECH ew0191 IM UN
COVID19 (COVID19 (PFIZER-BIONTECH)) 2 COVID19 PFIZER\BIONTECH EW0196 IM UN

RECVDATE:10-08-2021
RPT_DATE:
CAGE_YR:15
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:Y
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:
X_STAY:U
DISABLE:Y
RECOVD:N
LAB_DATA:MRI brain with and without contrast, MRI cervical/thoracic/lumbar spine (9/17/2021) MRA head without contrast (9/25/21) CT Chest/Abd/Pelvis (9/25/21) CTA Escape (9/26/21) CT Head without contrast (9/26/21) CT head low dose (9/29/21 and 10/1/21) CT Head without contrast (10/3/21) MRI Brain with and without contrast (10/6/2021) MRA head without contrast (10/7/21) MRI Thoracic/cervical spine (10/7/21)
V_ADMINBY:
OTHER_MEDS:None known
CUR_ILL:No other illnesses reported
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:10-08-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:No known drug allergies
V_FUNDBY:

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