National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1089419

History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1089419
VAERS Form:2
Age:60.0
Sex:Male
Location:Oklahoma
Vaccinated:2021-03-08
Onset:2021-03-09
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / N/A LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood creatinine increased, Blood culture, Culture urine, Diarrhoea, Full blood count, Blood urine present, Headache, Hypotension, Malaise, Nausea, Tachycardia, Urinary tract infection, Vomiting, Brain natriuretic peptide, Bloody discharge, Metabolic function test abnormal, Urine analysis abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zanaflex, Percocet, Xanax, Brilinta, Insulin
Current Illness:
Preexisting Conditions: Stage 4 kidney disease, nephrostomy, ulcerative colitis with colostomy, CAD with 2 CABG & 7 cardiac stents,
Allergies: Influenza Vaccine, Pneumonia vaccine, Ambien, Lisinopril, PCNs
Diagnostic Lab Data: CMP, CBC UA with C&S, BNP, blood cultures
CDC 'Split Type':

Write-up: Received COVID-19 Vaccine on 03/08/2021. About 7:00 am the next morning began having N/V x4 past 12 hrs, diarrhea x 6, headache and blood in urine. Chronic illness of stage 4 kidney disease with bilateral nephrostomy and acute bloody discharge, ulcerative colitis with colostomy and acute high output, CAD with 7 cardiac stents and 2 CABG. A&Ox4, Malaise, tachycardia and hypotension, afebrile. Patient reports chronic abdominal pain unchanged today. Denies back pain, chest pain, cough, or SHOB. Afebrile. Patient has new diagnosis of UTI. IV fluids administered, IV Zofran, Meropenem, and po Hydrocodone/APAP. Transferred due to creatinine of 4.3, bloody urine, and UTI. T: 98.1 HR 91, R-14 BP 106/71, O2 sat 97%


Changed on 5/7/2021

VAERS ID: 1089419 Before After
VAERS Form:2
Age:60.0
Sex:Male
Location:Oklahoma
Vaccinated:2021-03-08
Onset:2021-03-09
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / N/A LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood creatinine increased, Blood culture, Culture urine, Diarrhoea, Full blood count, Blood urine present, Headache, Hypotension, Malaise, Nausea, Tachycardia, Urinary tract infection, Vomiting, Brain natriuretic peptide, Bloody discharge, Metabolic function test abnormal, Urine analysis abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zanaflex, Percocet, Xanax, Brilinta, Insulin
Current Illness:
Preexisting Conditions: Stage 4 kidney disease, nephrostomy, ulcerative colitis with colostomy, CAD with 2 CABG & 7 cardiac stents,
Allergies: Influenza Vaccine, Pneumonia vaccine, Ambien, Lisinopril, PCNs PCNs
Diagnostic Lab Data: CMP, CBC UA with C&S, BNP, blood cultures
CDC 'Split Type':

Write-up: Received COVID-19 Vaccine on 03/08/2021. About 7:00 am the next morning began having N/V x4 past 12 hrs, diarrhea x 6, headache and blood in urine. Chronic illness of stage 4 kidney disease with bilateral nephrostomy and acute bloody discharge, ulcerative colitis with colostomy and acute high output, CAD with 7 cardiac stents and 2 CABG. A&Ox4, Malaise, tachycardia and hypotension, afebrile. Patient reports chronic abdominal pain unchanged today. Denies back pain, chest pain, cough, or SHOB. Afebrile. Patient has new diagnosis of UTI. IV fluids administered, IV Zofran, Meropenem, and po Hydrocodone/APAP. Transferred due to creatinine of 4.3, bloody urine, and UTI. T: 98.1 HR 91, R-14 BP 106/71, O2 sat 97%


Changed on 5/14/2021

VAERS ID: 1089419 Before After
VAERS Form:2
Age:60.0
Sex:Male
Location:Oklahoma
Vaccinated:2021-03-08
Onset:2021-03-09
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / N/A LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood creatinine increased, Blood culture, Culture urine, Diarrhoea, Full blood count, Blood urine present, Headache, Hypotension, Malaise, Nausea, Tachycardia, Urinary tract infection, Vomiting, Brain natriuretic peptide, Bloody discharge, Metabolic function test abnormal, Urine analysis abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Zanaflex, Percocet, Xanax, Brilinta, Insulin
Current Illness:
Preexisting Conditions: Stage 4 kidney disease, nephrostomy, ulcerative colitis with colostomy, CAD with 2 CABG & 7 cardiac stents,
Allergies: Influenza Vaccine, Pneumonia vaccine, Ambien, Lisinopril, PCNs PCNs
Diagnostic Lab Data: CMP, CBC UA with C&S, BNP, blood cultures
CDC 'Split Type':

Write-up: Received COVID-19 Vaccine on 03/08/2021. About 7:00 am the next morning began having N/V x4 past 12 hrs, diarrhea x 6, headache and blood in urine. Chronic illness of stage 4 kidney disease with bilateral nephrostomy and acute bloody discharge, ulcerative colitis with colostomy and acute high output, CAD with 7 cardiac stents and 2 CABG. A&Ox4, Malaise, tachycardia and hypotension, afebrile. Patient reports chronic abdominal pain unchanged today. Denies back pain, chest pain, cough, or SHOB. Afebrile. Patient has new diagnosis of UTI. IV fluids administered, IV Zofran, Meropenem, and po Hydrocodone/APAP. Transferred due to creatinine of 4.3, bloody urine, and UTI. T: 98.1 HR 91, R-14 BP 106/71, O2 sat 97%

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1089419&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166