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This is VAERS ID 1136622

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1136622
VAERS Form:2
Age:70.0
Sex:Male
Location:New York
Vaccinated:2021-03-24
Onset:2021-03-25
Submitted:0000-00-00
Entered:2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: ESRD on HD. Recent Covid
Preexisting Conditions: H/O of HTN, DM2 on insulin, CAD, HF mrEF, bradycardia s/p ppm, Gout.
Allergies: NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had cardiac arrest secondary to MI less than 24 hours from receiving the vaccine. Now on 3 pressors. Although due to the patient''s health condition, this may not have been attributed to the vaccine.


Changed on 5/7/2021

VAERS ID: 1136622 Before After
VAERS Form:2
Age:70.0
Sex:Male
Location:New York
Vaccinated:2021-03-24
Onset:2021-03-25
Submitted:0000-00-00
Entered:2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Cardiac arrest

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: ESRD on HD. Recent Covid
Preexisting Conditions: H/O of HTN, DM2 on insulin, CAD, HF mrEF, bradycardia s/p ppm, Gout.
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had cardiac arrest secondary to MI less than 24 hours from receiving the vaccine. Now on 3 pressors. Although due to the patient''s health condition, this may not have been attributed to the vaccine.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1136622&WAYBACKHISTORY=ON


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