VAERS ID: 956956

AGE: 44| SEX: F|STATE: CA (United States)

Description

Severe dissociative event (psychotic break) beginning <72hr after administration of vaccine, and continuing another 48 hours before resolution. Patient has no prior adverse psychiatric history. Transported to local ER on Monday 11th upon worsening of condition. Administered Haldol in the ER as a sedative after becoming combative during dissociative state. Patient woke up Tuesday the 12th with recurrent, but significantly diminished, dissociation, which had largely resolved by late Tuesday. Patient transported to Mental Health on a 5150. Released Friday the 15th around noon. No recurrent symptoms since.

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Symptoms

Computerised tomogram normal, Aggression, Toxicologic test normal, Dissociative disorder

Vaccines

VAX DATE: 01-07-2021| ONSET DATE: 01-11-2021| DAYS TO ONSET: 4
NameDose #TypeManufacturerLotRouteSite
COVID19 (COVID19 (MODERNA)) 1 COVID19 MODERNA 025L20A IM LA

RECVDATE:01-19-2021
RPT_DATE:
CAGE_YR:44
CAGE_MO:
DIED:U
DATEDIED:
L_THREAT:U
ER_VISIT:
HOSPITAL:Y
HOSPDAYS:3
X_STAY:U
DISABLE:U
RECOVD:Y
LAB_DATA:Tox screen negative except for low-level (<0.08BAC) alcohol. CAT scan showed nothing to indicate pressure or physical stress to the brain.
V_ADMINBY:PVT
OTHER_MEDS:Women's multivitamin Women's probiotic Cod Liver Oil Vitamin D3 gummies OsteoBiflex B complex THC gummies, 2.5mg one dose Milk kefir L-theanine
CUR_ILL:
HISTORY:GERD, asthma
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:
TODAYS_DATE:01-19-2021
BIRTH_DEFECT:U
OFC_VISIT:U
ER_ED_VISIT:U
ALLERGIES:Cephalosporin, coedine
V_FUNDBY:

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