Adverse Event Reporting
| VAERS ID | 1002636 |
|---|---|
| Gender | Female |
| Age | 90 |
| StateCode | WA |
| Pharmaceutical Company | MODERNA |
| Lot Number | 025J20A |
| Number of vaccinations | 1 |
| Vaccinated | 2020-12-28 |
| Onset | 2021-01-17 |
| Condition | Hospitalized Life Threatening Permanent Disability Died |
Symptoms
- Fall
- Angiogram
- Computerised tomogram abnormal
- Computerised tomogram head
- Angiogram cerebral abnormal
- Aphasia
- Death
- Movement disorder
- Nervous system disorder
- Cerebral artery occlusion
- Thrombectomy
- NIH stroke scale score increased
Current Illness
None - had exposure to COVID19 + case on 12/18/2020 but tested negative.
Preexisting Conditions
CHF, HTN, hyperlipidemia, atrial fibrillation, COPD (O2 dependent) , CKD Stage 4, type 2 diabetes (diet controlled).
Other Medications
ASA 81 mg, allopurinol, potassium chloride, furosemide, diltiazem, metoprolol, tiotropium, albuterol, diclofenac gel topical
Previous Vaccinations
Allergies
Oxycodone, Percodan, atenolol, PCN VK
Laboratory Data
CT 1/17/21 (no acute hemorrhage but mild hypodensity of greater than 1/3 of the MCA territory) and CT Angiogram on 1/17/21 ( distal L M1/M2 occulsion).
Write-up
On 1/17/2021 patient woke and began her day as usual, was found down by family member 1 hour later conscious but unable to speak and unable to move her R side.
She was admitted to the hospital - Initial NIHSS was 26 and CT imaging showed no acute hemorrhage but mild hypodensity of greater than 1/3 of the MCA territory (TPA not recommended).
CTA did show distal L M1/M2 occulsion and she was transferred to larger facility for thrombectomy.
Unfortunately the patient had persistent severe neurological deficits after thrombectomy.
Was discharged home on hospice care and expired on 1/23/21.