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This is VAERS ID 1081167

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1081167
VAERS Form:2
Age:41.0
Sex:Male
Location:Virginia
Vaccinated:2021-03-06
Onset:2021-03-07
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood creatine phosphokinase, Blood magnesium, Blood thyroid stimulating hormone, Chest X-ray, Echocardiogram, Electrocardiogram, Full blood count, Hepatitis C antibody, Loss of consciousness, Unresponsive to stimuli, Troponin I, Computerised tomogram head, Troponin, Metabolic function test, Respiratory syncytial virus test, Influenza A virus test, Influenza B virus test, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Men''s One A Day Multivitamin, Metoprolol Tartrate 25 MG 2x a day, Ezetimibe 10 MG 1 a day around 8pm, Bayer Aspirin Low Dose 81 MG 1 a day, Atorvastatin Calcium 80MG 1 a day around 8pm.
Current Illness: N/A
Preexisting Conditions: Heart Disease
Allergies: N/A
Diagnostic Lab Data: 3/7/2021 Troponin Stat (ITRP) Basic Metabolic Panel (BMP) CBC with Auto Diff (CBCD) CK (CK) Hepatitis C Custom Reflex (HCCR) Magnesium (MG) Sars COV 2, INFLU. A?B, RSV PCR (COFRP) Troponini I (TROP) Performed 2 times TSH (TSH) CT Head/Brain WO Cont EKG (12-Lead) XR Chest 1 VW ECHO
CDC 'Split Type':

Write-up: Woke up around 5:30AM having to go to the bathroom. Went to Flush the toilet and passed out on the floor. My wife found me unresponsive but breathing on the floor. My wife called 911 and was at the hospital around 6:15AM.


Changed on 5/7/2021

VAERS ID: 1081167 Before After
VAERS Form:2
Age:41.0
Sex:Male
Location:Virginia
Vaccinated:2021-03-06
Onset:2021-03-07
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood creatine phosphokinase, Blood magnesium, Blood thyroid stimulating hormone, Chest X-ray, Echocardiogram, Electrocardiogram, Full blood count, Hepatitis C antibody, Loss of consciousness, Unresponsive to stimuli, Troponin I, Computerised tomogram head, Troponin, Metabolic function test, Respiratory syncytial virus test, Influenza A virus test, Influenza B virus test, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Men''s One A Day Multivitamin, Metoprolol Tartrate 25 MG 2x a day, Ezetimibe 10 MG 1 a day around 8pm, Bayer Aspirin Low Dose 81 MG 1 a day, Atorvastatin Calcium 80MG 1 a day around 8pm.
Current Illness: N/A
Preexisting Conditions: Heart Disease
Allergies: N/A N/A
Diagnostic Lab Data: 3/7/2021 Troponin Stat (ITRP) Basic Metabolic Panel (BMP) CBC with Auto Diff (CBCD) CK (CK) Hepatitis C Custom Reflex (HCCR) Magnesium (MG) Sars COV 2, INFLU. A?B, RSV PCR (COFRP) Troponini I (TROP) Performed 2 times TSH (TSH) CT Head/Brain WO Cont EKG (12-Lead) XR Chest 1 VW ECHO
CDC 'Split Type':

Write-up: Woke up around 5:30AM having to go to the bathroom. Went to Flush the toilet and passed out on the floor. My wife found me unresponsive but breathing on the floor. My wife called 911 and was at the hospital around 6:15AM.


Changed on 5/14/2021

VAERS ID: 1081167 Before After
VAERS Form:2
Age:41.0
Sex:Male
Location:Virginia
Vaccinated:2021-03-06
Onset:2021-03-07
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood creatine phosphokinase, Blood magnesium, Blood thyroid stimulating hormone, Chest X-ray, Echocardiogram, Electrocardiogram, Full blood count, Hepatitis C antibody, Loss of consciousness, Unresponsive to stimuli, Troponin I, Computerised tomogram head, Troponin, Metabolic function test, Respiratory syncytial virus test, Influenza A virus test, Influenza B virus test, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Men''s One A Day Multivitamin, Metoprolol Tartrate 25 MG 2x a day, Ezetimibe 10 MG 1 a day around 8pm, Bayer Aspirin Low Dose 81 MG 1 a day, Atorvastatin Calcium 80MG 1 a day around 8pm.
Current Illness: N/A
Preexisting Conditions: Heart Disease
Allergies: N/A N/A
Diagnostic Lab Data: 3/7/2021 Troponin Stat (ITRP) Basic Metabolic Panel (BMP) CBC with Auto Diff (CBCD) CK (CK) Hepatitis C Custom Reflex (HCCR) Magnesium (MG) Sars COV 2, INFLU. A?B, RSV PCR (COFRP) Troponini I (TROP) Performed 2 times TSH (TSH) CT Head/Brain WO Cont EKG (12-Lead) XR Chest 1 VW ECHO
CDC 'Split Type':

Write-up: Woke up around 5:30AM having to go to the bathroom. Went to Flush the toilet and passed out on the floor. My wife found me unresponsive but breathing on the floor. My wife called 911 and was at the hospital around 6:15AM.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1081167&WAYBACKHISTORY=ON


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