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This is VAERS ID 1087806

History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1087806
VAERS Form:2
Age:48.0
Sex:Male
Location:Oklahoma
Vaccinated:2021-03-09
Onset:2021-03-09
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Aphasia, Computerised tomogram, Full blood count, Headache, Joint stiffness, Mental status changes, Metabolic function test, Seizure like phenomena

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? No
Previous Vaccinations:
Other Medications: Keppra, Xarelto, Atorvastatin
Current Illness: None stated
Preexisting Conditions: Seizures, history of stroke
Allergies: Penicillan
Diagnostic Lab Data: CT of the head - no acute findings CBC/BMP within normal limits
CDC 'Split Type':

Write-up: Within 30 minutes post vaccine administration, patient started having seizure like symptoms (Altered mental status, clenched jaw, non-verbal, right sided headache) - V/S WNL, Ambulance called and patient was taken to ED for evaluation. Responsive during transport to ED. Patient reported back to baseline after 1.5 hours.


Changed on 5/7/2021

VAERS ID: 1087806 Before After
VAERS Form:2
Age:48.0
Sex:Male
Location:Oklahoma
Vaccinated:2021-03-09
Onset:2021-03-09
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Aphasia, Computerised tomogram, Full blood count, Headache, Joint stiffness, Mental status changes, Metabolic function test, Seizure like phenomena

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? No
Previous Vaccinations:
Other Medications: Keppra, Xarelto, Atorvastatin
Current Illness: None stated
Preexisting Conditions: Seizures, history of stroke
Allergies: Penicillan Penicillan
Diagnostic Lab Data: CT of the head - no acute findings CBC/BMP within normal limits
CDC 'Split Type':

Write-up: Within 30 minutes post vaccine administration, patient started having seizure like symptoms (Altered mental status, clenched jaw, non-verbal, right sided headache) - V/S WNL, Ambulance called and patient was taken to ED for evaluation. Responsive during transport to ED. Patient reported back to baseline after 1.5 hours.


Changed on 5/14/2021

VAERS ID: 1087806 Before After
VAERS Form:2
Age:48.0
Sex:Male
Location:Oklahoma
Vaccinated:2021-03-09
Onset:2021-03-09
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Aphasia, Computerised tomogram, Full blood count, Headache, Joint stiffness, Mental status changes, Metabolic function test, Seizure like phenomena

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? No
Previous Vaccinations:
Other Medications: Keppra, Xarelto, Atorvastatin
Current Illness: None stated
Preexisting Conditions: Seizures, history of stroke
Allergies: Penicillan Penicillan
Diagnostic Lab Data: CT of the head - no acute findings CBC/BMP within normal limits
CDC 'Split Type':

Write-up: Within 30 minutes post vaccine administration, patient started having seizure like symptoms (Altered mental status, clenched jaw, non-verbal, right sided headache) - V/S WNL, Ambulance called and patient was taken to ED for evaluation. Responsive during transport to ED. Patient reported back to baseline after 1.5 hours.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1087806&WAYBACKHISTORY=ON


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