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This is VAERS ID 1147356

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1147356
VAERS Form:2
Age:59.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-03-13
Onset:2021-03-29
Submitted:0000-00-00
Entered:2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Bradykinesia, Cough, Pneumonia, Pyrexia, Tachycardia, Mental status changes, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
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: aspirin, glipizide, metformin
Current Illness:
Preexisting Conditions: Diabetic retinopathy of both eyes, hyperlipidemia, leukopenia, kaposi sarcoma, hemorrhoids, diabetes "1.5", managed as type 2, depression, carotid artery disease, AVM (congenital), allergic rhinitis.
Allergies: Shellfish (anaphylaxis), adhesive tape, aluminum, horse derived products (positive during allergy testing), latex
Diagnostic Lab Data: 3/29/2021: Positive SARS-CoV-2 PCR NP
CDC 'Split Type':

Write-up: Pt received dose of J&J vaccine (Janssen) on 3/13/2021. Symptoms began around 3/27 similar to COVID-19. Pt presented to ED at another local hospital 3/29/2021, tested positive for COVID-19 and was transferred to be admitted to our hospital for treatment of COVID-19. Notes from hospital admission H&P: Patient is a 59 y.o. male with history DM, Who presented to Urgent care then hospital ER with covid positive, PNA, Fever and a cough. Real tachycardic there to 117, temp to 103, confused, moving slow. Altered mental status (slow cognition), 94% on 2L"


Changed on 5/7/2021

VAERS ID: 1147356 Before After
VAERS Form:2
Age:59.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-03-13
Onset:2021-03-29
Submitted:0000-00-00
Entered:2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Bradykinesia, Cough, Pneumonia, Pyrexia, Tachycardia, Mental status changes, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
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: aspirin, glipizide, metformin
Current Illness:
Preexisting Conditions: Diabetic retinopathy of both eyes, hyperlipidemia, leukopenia, kaposi sarcoma, hemorrhoids, diabetes "1.5", managed as type 2, depression, carotid artery disease, AVM (congenital), allergic rhinitis.
Allergies: Shellfish (anaphylaxis), adhesive tape, aluminum, horse derived products (positive during allergy testing), latex latex
Diagnostic Lab Data: 3/29/2021: Positive SARS-CoV-2 PCR NP
CDC 'Split Type':

Write-up: Pt received dose of J&J vaccine (Janssen) on 3/13/2021. Symptoms began around 3/27 similar to COVID-19. Pt presented to ED at another local hospital 3/29/2021, tested positive for COVID-19 and was transferred to be admitted to our hospital for treatment of COVID-19. Notes from hospital admission H&P: Patient is a 59 y.o. male with history DM, Who presented to Urgent care then hospital ER with covid positive, PNA, Fever and a cough. Real tachycardic there to 117, temp to 103, confused, moving slow. Altered mental status (slow cognition), 94% on 2L"

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1147356&WAYBACKHISTORY=ON


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