Adverse Event Reporting

VAERS ID 2503173
Gender Male
Age 81
StateCode MI
Pharmaceutical Company MODERNA
Lot Number 939904
Number of vaccinations 3
Vaccinated 2021-10-29
Onset 2022-11-02
Condition Hospitalized Recovered
  • Memory impairment
  • Pyrexia
  • Electrocardiogram normal
  • Asthenia
  • Cough
  • Fall
  • Chest X-ray normal
  • Full blood count normal
  • Metabolic function test normal
  • Urine analysis normal
  • SARS-CoV-2 test positive
  • COVID-19
  • Exposure to SARS-CoV-2
  • Computerised tomogram head abnormal
  • Face injury
  • Encephalopathy
  • Cerebral atrophy

Current Illness

Preexisting Conditions

Oropharyngeal dysphagia Essential hypertension Mixed dementia (HCC) Ulcerative esophagitis Vitamin B 12 deficiency Macular degeneration Glaucoma Charcot-Marie-Tooth disease hyperlipidemia Moderate episode of recurrent major depressive disorder (HCC) Rhinophyma History of stroke History of alcoholism (HCC) Tubular adenoma Elevated bilirubin History of partial colectomy Advance care planning Weight gain Falls Generalized weakness

Other Medications

acetaminophen (TYLENOL) 500 MG tablet Ascorbic Acid (VITAMIN C GUMMIE PO) aspirin 81 MG enteric coated tablet Carboxymethylcellul-Glycerin (REFRESH OPTIVE) 0.5-0.9 % SOLN clopidogrel (PLAVIX) 75 MG tablet Cyanocobalamin (B-12 PO) escitalopr

Previous Vaccinations



Laboratory Data


Discharge Provider: MD Primary Care Provider : MD Admitting Service: Internal Medicine Service Admission Date: 11/2/2022 Discharge Date: 11/08/2022 PRESENTING PROBLEM: Acute encephalopathy HOSPITAL COURSE: Patient is an 82-year-old male with a past medical history significant for hypertension, PCA CVA, dementia, alcohol use disorder remotely who presented to the emergency department with a chief complaint of 2 falls in the 48 hours prior to admission.
The patient tested positive for COVID-19 on 11/01/2022 with a home test.
He had mild symptoms of fever and dry cough.
His wife also was sick with COVID-19 and was unable to care for him due to generalized weakness and falls in the setting of dementia.
His memory issues had worsened with his acute illness.
He fell on the day prior to admission and hit his face per his wife's report.
He was brought to the emergency department.
In the emergency department, he was hemodynamically stable, not hypoxic and afebrile.
Complete blood count and CMP were unremarkable.
COVID-19 PCR was positive.
Urinalysis was negative for infection.
EKG showed normal sinus rhythm.
Chest x-ray was unremarkable.
CT head showed moderate volume loss and old right PCA CVA without acute process.
He was given fluids and Tylenol.
He was admitted to the hospitalist service for COVID-19 with fall and placement.
PT/OT re-evaluated him on 11/07/2022.
They recommended Home with home health, eventually discharged home in relatively stable condition on 11/08/2022.