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This is VAERS ID 1180066

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1180066
VAERS Form:2
Age:74.0
Sex:Male
Location:Illinois
Vaccinated:2021-03-08
Onset:2021-04-06
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: Alanine aminotransferase increased, Albumin globulin ratio, Aspartate aminotransferase increased, Basophil count decreased, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium decreased, Blood chloride decreased, Blood creatinine increased, Blood glucose normal, Blood potassium normal, Blood sodium decreased, Blood urea normal, Chest X-ray normal, Dyspnoea, Electrocardiogram, Eosinophil count decreased, Fibrin D dimer increased, Glomerular filtration rate decreased, Haematocrit decreased, Haemoglobin normal, Lymphocyte count normal, Mean cell haemoglobin concentration increased, Mean cell haemoglobin increased, Mean cell volume normal, Monocyte count normal, Neutrophil count decreased, Platelet count normal, Protein total normal, Red blood cell count decreased, Rhinorrhoea, White blood cell count normal, Eosinophil percentage decreased, Neutrophil percentage decreased, Monocyte percentage increased, Brain natriuretic peptide normal, Red cell distribution width normal, Mean platelet volume normal, Basophil percentage, Lymphocyte percentage, SARS-CoV-2 test negative, Immature granulocyte count

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? No
Previous Vaccinations:
Other Medications: Current Outpatient Medications: ? aspirin 325 MG tablet, Take 325 mg by mouth daily Takes 1/2 tablet, Disp: , Rfl: ? Cholecalciferol (VITAMIN D) 1000 UNITS CAPS, Take 5,000 Units by mouth daily, Disp: , Rfl: ? lisinopril-hydrochloroth
Current Illness:
Preexisting Conditions:
Allergies: Allergen Reactions ? Novocain
Diagnostic Lab Data: Comprehensive metabolic panel [200568102] (Abnormal) Collected: 04/06/21 2105 Order Status: Completed Specimen: Blood Updated: 04/06/21 2214 Glucose 128High 65 - 100 MG/DL Blood Urea Nitrogen 17 7 - 18 MG/DL Creatinine 1.6High 0.7 - 1.3 MG/DL Sodium 132Low 136 - 145 MMOL/L Potassium 3.5 3.5 - 5.1 MMOL/L Chloride 95Low 98 - 107 MMOL/L Co2 26 21 - 32 MMOL/L Calcium 8.4Low 8.5 - 10.1 MG/DL Protein Total 7.1 6.4 - 8.2 G/DL Albumin 3.4 3.4 - 5.0 G/DL A/G Ratio 0.9 0.8 - 2.0 Alkaline Phosphatase 49 46 - 116 U/L Alt (SGPT) 50 16 - 63 U/L AST(SGOT) 46High 15 - 37 U/L Bilirubin, Total 0.4 0.2 - 1.0 MG/DL GFR Comment IF PATIENT IS AFRICAN AMERICAN, MULTIPLY RESULT BY 1.16 Est GFR 42Low $g90 ML/MIN/1.73sq.m NOVEL CORONAVIRUS SARS-COV-2 BY PCR [200568111] Collected: 04/06/21 2116 Order Status: Completed Updated: 04/06/21 2205 SARS-COV-2 Source NASOPHARYNGEAL SARS-COV-2 By PCR Not Detected Not Detected Comment: THIS TEST HAS BEEN VALIDATED BUT FDA''S INDEPENDENT REVIEW OF THE VALIDATION IS PENDING. THIS TEST IS PERFORMED AS A LABORATORY DEVELOPED TEST, INDEPENDENT REVIEW OF THE VALIDATION UNDER THE FDA''S EMERGENCY USE AUTHORIZATION (EUA) AUTHORITY WILL BE PERFORMED ACCORDING TO CURRENT GUIDANCE REQUIREMENTS. ********** WE WILL CONTINUE TO FOLLOW FEDERAL AND STATE REQUIREMENTS FOR BOTH NOTIFICATION OF RESULTS AND ANY CONFIRMATORY TESTING D-dimer, quantitative [200568107] (Abnormal) Collected: 04/06/21 2105 Order Status: Completed Specimen: Blood Updated: 04/06/21 2148 D-Dimer 402High 0 - 400 NG/ML FEU EKG [200568103] Resulted: 04/06/21 Order Status: Completed Updated: 04/06/21 2142 XR Chest 2 View [200568105] Collected: 04/06/21 2107 Order Status: Completed Updated: 04/06/21 2139 Narrative: XR CHEST 2 VIEWS CLINICAL INFORMATION: Shortness of breath TECHNIQUE: PA and lateral views. 2 images. COMPARISON: Chest radiograph October 27, 2014 FINDINGS: Lungs and pleura: Normal lung inflation. No focal consolidation, pleural effusion or pneumothorax Heart and mediastinum: Cardiomediastinal silhouette is normal size. Normal pulmonary vasculature Bones and chest wall: No suspicious osseous abnormalities Lines and tubes: None. IMPRESSION: No acute cardiopulmonary disease. Electronically signed by: MD 4/6/2021 9:38 PM : 109-1082 Brain Natriuretic Peptide (BNP) [200568104] Collected: 04/06/21 2105 Order Status: Completed Specimen: Blood Updated: 04/06/21 2137 B-Type Natriuretic Peptide 13 0 - 100 PG/ML CBC w Auto Diff [200568101] (Abnormal) Collected: 04/06/21 2105 Order Status: Completed Specimen: Blood Updated: 04/06/21 2113 White Blood Cell Count 3.9Low 4.8 - 9.6 THOUS/uL Red Blood Cell Count 4.09Low 4.33 - 5.59 MIL/uL Hemoglobin 13.5 13.1 - 16.8 GM/DL Hematocrit 37.3Low 38.8 - 49.0 % Mean Corpuscular Volume 91.2 82.7 - 94.4 FL Mean Corpuscular Hemoglobin 33.0High 27.7 - 32.6 PG Mean Corpuscular Hemoglobin Conc 36.2High 32.4 - 35.7 G/DL Rdwcv 12.2 11.6 - 13.9 % Rdwsd 40.6 36.0 - 46.1 FL Platelet Count 165 154 - 364 THOUS/uL Mean Platelet Volume 9.9 8.7 - 11.7 FL Nucleated Red Blood Cells 0.0 0.0 /100 WBC''S Abs NRBC 0.0 0.0 THOUS/uL Differential Type AUTO Neutrophils 47.2 34.0 - 67.9 % Lymphs 35.2 19.1 - 41.2 % Monocytes 15.5High 6.1 - 12.3 % Eos 0.8Low 0.9 - 7.6 % Basos 1.0 0.2 - 1.5 % Neutrophils Absolute Count 1.8Low 2.7 - 5.8 THOUS/uL Lymphocytes Absolute Count 1.4 1.1 - 3.3 THOUS/uL Monocytes Absolute Count 0.6 0.4 - 0.9 THOUS/uL Eosinophils Absolute Count 0.0Low 0.1 - 0.6 THOUS/uL Basophils Absolute Count 0.0 0.0 - 0.1 THOUS/uL Imm Gran 0.3 0.2 - 0.9 % Abs Imm Gran 0.01 0.0 - 0.1 THOUS/uL
CDC 'Split Type':

Write-up: 4/6/12 ER HPI: 74 y.o. male who presents with complaint of shortness of breath that is worse after eating for 3 weeks. Patient said he had received a his copied vaccine 3 weeks ago. No cough, no chest pain, no abdominal pain nausea vomiting, no palpitations and no fever or chills Shortness of Breath: Started 3 weeks ago and getting worse. Received covid vaccine 3 weeks ago and started then. No cough. Dyspnea on exertion. No fever. Early am he has had runny noses. No inhalers or nebs. Not smoker


Changed on 5/7/2021

VAERS ID: 1180066 Before After
VAERS Form:2
Age:74.0
Sex:Male
Location:Illinois
Vaccinated:2021-03-08
Onset:2021-04-06
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: Alanine aminotransferase increased, Albumin globulin ratio, Aspartate aminotransferase increased, Basophil count decreased, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium decreased, Blood chloride decreased, Blood creatinine increased, Blood glucose normal, Blood potassium normal, Blood sodium decreased, Blood urea normal, Chest X-ray normal, Dyspnoea, Electrocardiogram, Eosinophil count decreased, Fibrin D dimer increased, Glomerular filtration rate decreased, Haematocrit decreased, Haemoglobin normal, Lymphocyte count normal, Mean cell haemoglobin concentration increased, Mean cell haemoglobin increased, Mean cell volume normal, Monocyte count normal, Neutrophil count decreased, Platelet count normal, Protein total normal, Red blood cell count decreased, Rhinorrhoea, White blood cell count normal, Eosinophil percentage decreased, Neutrophil percentage decreased, Monocyte percentage increased, Brain natriuretic peptide normal, Red cell distribution width normal, Mean platelet volume normal, Basophil percentage, Lymphocyte percentage, SARS-CoV-2 test negative, Immature granulocyte count

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? No
Previous Vaccinations:
Other Medications: Current Outpatient Medications: ? aspirin 325 MG tablet, Take 325 mg by mouth daily Takes 1/2 tablet, Disp: , Rfl: ? Cholecalciferol (VITAMIN D) 1000 UNITS CAPS, Take 5,000 Units by mouth daily, Disp: , Rfl: ? lisinopril-hydrochloroth
Current Illness:
Preexisting Conditions:
Allergies: Allergen Reactions ? Novocain Novocain
Diagnostic Lab Data: Comprehensive metabolic panel [200568102] (Abnormal) Collected: 04/06/21 2105 Order Status: Completed Specimen: Blood Updated: 04/06/21 2214 Glucose 128High 65 - 100 MG/DL Blood Urea Nitrogen 17 7 - 18 MG/DL Creatinine 1.6High 0.7 - 1.3 MG/DL Sodium 132Low 136 - 145 MMOL/L Potassium 3.5 3.5 - 5.1 MMOL/L Chloride 95Low 98 - 107 MMOL/L Co2 26 21 - 32 MMOL/L Calcium 8.4Low 8.5 - 10.1 MG/DL Protein Total 7.1 6.4 - 8.2 G/DL Albumin 3.4 3.4 - 5.0 G/DL A/G Ratio 0.9 0.8 - 2.0 Alkaline Phosphatase 49 46 - 116 U/L Alt (SGPT) 50 16 - 63 U/L AST(SGOT) 46High 15 - 37 U/L Bilirubin, Total 0.4 0.2 - 1.0 MG/DL GFR Comment IF PATIENT IS AFRICAN AMERICAN, MULTIPLY RESULT BY 1.16 Est GFR 42Low $g90 ML/MIN/1.73sq.m NOVEL CORONAVIRUS SARS-COV-2 BY PCR [200568111] Collected: 04/06/21 2116 Order Status: Completed Updated: 04/06/21 2205 SARS-COV-2 Source NASOPHARYNGEAL SARS-COV-2 By PCR Not Detected Not Detected Comment: THIS TEST HAS BEEN VALIDATED BUT FDA''S INDEPENDENT REVIEW OF THE VALIDATION IS PENDING. THIS TEST IS PERFORMED AS A LABORATORY DEVELOPED TEST, INDEPENDENT REVIEW OF THE VALIDATION UNDER THE FDA''S EMERGENCY USE AUTHORIZATION (EUA) AUTHORITY WILL BE PERFORMED ACCORDING TO CURRENT GUIDANCE REQUIREMENTS. ********** WE WILL CONTINUE TO FOLLOW FEDERAL AND STATE REQUIREMENTS FOR BOTH NOTIFICATION OF RESULTS AND ANY CONFIRMATORY TESTING D-dimer, quantitative [200568107] (Abnormal) Collected: 04/06/21 2105 Order Status: Completed Specimen: Blood Updated: 04/06/21 2148 D-Dimer 402High 0 - 400 NG/ML FEU EKG [200568103] Resulted: 04/06/21 Order Status: Completed Updated: 04/06/21 2142 XR Chest 2 View [200568105] Collected: 04/06/21 2107 Order Status: Completed Updated: 04/06/21 2139 Narrative: XR CHEST 2 VIEWS CLINICAL INFORMATION: Shortness of breath TECHNIQUE: PA and lateral views. 2 images. COMPARISON: Chest radiograph October 27, 2014 FINDINGS: Lungs and pleura: Normal lung inflation. No focal consolidation, pleural effusion or pneumothorax Heart and mediastinum: Cardiomediastinal silhouette is normal size. Normal pulmonary vasculature Bones and chest wall: No suspicious osseous abnormalities Lines and tubes: None. IMPRESSION: No acute cardiopulmonary disease. Electronically signed by: MD 4/6/2021 9:38 PM : 109-1082 Brain Natriuretic Peptide (BNP) [200568104] Collected: 04/06/21 2105 Order Status: Completed Specimen: Blood Updated: 04/06/21 2137 B-Type Natriuretic Peptide 13 0 - 100 PG/ML CBC w Auto Diff [200568101] (Abnormal) Collected: 04/06/21 2105 Order Status: Completed Specimen: Blood Updated: 04/06/21 2113 White Blood Cell Count 3.9Low 4.8 - 9.6 THOUS/uL Red Blood Cell Count 4.09Low 4.33 - 5.59 MIL/uL Hemoglobin 13.5 13.1 - 16.8 GM/DL Hematocrit 37.3Low 38.8 - 49.0 % Mean Corpuscular Volume 91.2 82.7 - 94.4 FL Mean Corpuscular Hemoglobin 33.0High 27.7 - 32.6 PG Mean Corpuscular Hemoglobin Conc 36.2High 32.4 - 35.7 G/DL Rdwcv 12.2 11.6 - 13.9 % Rdwsd 40.6 36.0 - 46.1 FL Platelet Count 165 154 - 364 THOUS/uL Mean Platelet Volume 9.9 8.7 - 11.7 FL Nucleated Red Blood Cells 0.0 0.0 /100 WBC''S Abs NRBC 0.0 0.0 THOUS/uL Differential Type AUTO Neutrophils 47.2 34.0 - 67.9 % Lymphs 35.2 19.1 - 41.2 % Monocytes 15.5High 6.1 - 12.3 % Eos 0.8Low 0.9 - 7.6 % Basos 1.0 0.2 - 1.5 % Neutrophils Absolute Count 1.8Low 2.7 - 5.8 THOUS/uL Lymphocytes Absolute Count 1.4 1.1 - 3.3 THOUS/uL Monocytes Absolute Count 0.6 0.4 - 0.9 THOUS/uL Eosinophils Absolute Count 0.0Low 0.1 - 0.6 THOUS/uL Basophils Absolute Count 0.0 0.0 - 0.1 THOUS/uL Imm Gran 0.3 0.2 - 0.9 % Abs Imm Gran 0.01 0.0 - 0.1 THOUS/uL
CDC 'Split Type':

Write-up: 4/6/12 ER HPI: 74 y.o. male who presents with complaint of shortness of breath that is worse after eating for 3 weeks. Patient said he had received a his copied vaccine 3 weeks ago. No cough, no chest pain, no abdominal pain nausea vomiting, no palpitations and no fever or chills Shortness of Breath: Started 3 weeks ago and getting worse. Received covid vaccine 3 weeks ago and started then. No cough. Dyspnea on exertion. No fever. Early am he has had runny noses. No inhalers or nebs. Not smoker


Changed on 5/14/2021

VAERS ID: 1180066 Before After
VAERS Form:2
Age:74.0
Sex:Male
Location:Illinois
Vaccinated:2021-03-08
Onset:2021-04-06
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: Alanine aminotransferase increased, Albumin globulin ratio, Aspartate aminotransferase increased, Basophil count decreased, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium decreased, Blood chloride decreased, Blood creatinine increased, Blood glucose normal, Blood potassium normal, Blood sodium decreased, Blood urea normal, Chest X-ray normal, Dyspnoea, Electrocardiogram, Eosinophil count decreased, Fibrin D dimer increased, Glomerular filtration rate decreased, Haematocrit decreased, Haemoglobin normal, Lymphocyte count normal, Mean cell haemoglobin concentration increased, Mean cell haemoglobin increased, Mean cell volume normal, Monocyte count normal, Neutrophil count decreased, Platelet count normal, Protein total normal, Red blood cell count decreased, Rhinorrhoea, White blood cell count normal, Eosinophil percentage decreased, Neutrophil percentage decreased, Monocyte percentage increased, Brain natriuretic peptide normal, Red cell distribution width normal, Mean platelet volume normal, Basophil percentage, Lymphocyte percentage, SARS-CoV-2 test negative, Immature granulocyte count

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? No
Previous Vaccinations:
Other Medications: Current Outpatient Medications: ? aspirin 325 MG tablet, Take 325 mg by mouth daily Takes 1/2 tablet, Disp: , Rfl: ? Cholecalciferol (VITAMIN D) 1000 UNITS CAPS, Take 5,000 Units by mouth daily, Disp: , Rfl: ? lisinopril-hydrochloroth
Current Illness:
Preexisting Conditions:
Allergies: Allergen Reactions ? Novocain Novocain
Diagnostic Lab Data: Comprehensive metabolic panel [200568102] (Abnormal) Collected: 04/06/21 2105 Order Status: Completed Specimen: Blood Updated: 04/06/21 2214 Glucose 128High 65 - 100 MG/DL Blood Urea Nitrogen 17 7 - 18 MG/DL Creatinine 1.6High 0.7 - 1.3 MG/DL Sodium 132Low 136 - 145 MMOL/L Potassium 3.5 3.5 - 5.1 MMOL/L Chloride 95Low 98 - 107 MMOL/L Co2 26 21 - 32 MMOL/L Calcium 8.4Low 8.5 - 10.1 MG/DL Protein Total 7.1 6.4 - 8.2 G/DL Albumin 3.4 3.4 - 5.0 G/DL A/G Ratio 0.9 0.8 - 2.0 Alkaline Phosphatase 49 46 - 116 U/L Alt (SGPT) 50 16 - 63 U/L AST(SGOT) 46High 15 - 37 U/L Bilirubin, Total 0.4 0.2 - 1.0 MG/DL GFR Comment IF PATIENT IS AFRICAN AMERICAN, MULTIPLY RESULT BY 1.16 Est GFR 42Low $g90 ML/MIN/1.73sq.m NOVEL CORONAVIRUS SARS-COV-2 BY PCR [200568111] Collected: 04/06/21 2116 Order Status: Completed Updated: 04/06/21 2205 SARS-COV-2 Source NASOPHARYNGEAL SARS-COV-2 By PCR Not Detected Not Detected Comment: THIS TEST HAS BEEN VALIDATED BUT FDA''S INDEPENDENT REVIEW OF THE VALIDATION IS PENDING. THIS TEST IS PERFORMED AS A LABORATORY DEVELOPED TEST, INDEPENDENT REVIEW OF THE VALIDATION UNDER THE FDA''S EMERGENCY USE AUTHORIZATION (EUA) AUTHORITY WILL BE PERFORMED ACCORDING TO CURRENT GUIDANCE REQUIREMENTS. ********** WE WILL CONTINUE TO FOLLOW FEDERAL AND STATE REQUIREMENTS FOR BOTH NOTIFICATION OF RESULTS AND ANY CONFIRMATORY TESTING D-dimer, quantitative [200568107] (Abnormal) Collected: 04/06/21 2105 Order Status: Completed Specimen: Blood Updated: 04/06/21 2148 D-Dimer 402High 0 - 400 NG/ML FEU EKG [200568103] Resulted: 04/06/21 Order Status: Completed Updated: 04/06/21 2142 XR Chest 2 View [200568105] Collected: 04/06/21 2107 Order Status: Completed Updated: 04/06/21 2139 Narrative: XR CHEST 2 VIEWS CLINICAL INFORMATION: Shortness of breath TECHNIQUE: PA and lateral views. 2 images. COMPARISON: Chest radiograph October 27, 2014 FINDINGS: Lungs and pleura: Normal lung inflation. No focal consolidation, pleural effusion or pneumothorax Heart and mediastinum: Cardiomediastinal silhouette is normal size. Normal pulmonary vasculature Bones and chest wall: No suspicious osseous abnormalities Lines and tubes: None. IMPRESSION: No acute cardiopulmonary disease. Electronically signed by: MD 4/6/2021 9:38 PM : 109-1082 Brain Natriuretic Peptide (BNP) [200568104] Collected: 04/06/21 2105 Order Status: Completed Specimen: Blood Updated: 04/06/21 2137 B-Type Natriuretic Peptide 13 0 - 100 PG/ML CBC w Auto Diff [200568101] (Abnormal) Collected: 04/06/21 2105 Order Status: Completed Specimen: Blood Updated: 04/06/21 2113 White Blood Cell Count 3.9Low 4.8 - 9.6 THOUS/uL Red Blood Cell Count 4.09Low 4.33 - 5.59 MIL/uL Hemoglobin 13.5 13.1 - 16.8 GM/DL Hematocrit 37.3Low 38.8 - 49.0 % Mean Corpuscular Volume 91.2 82.7 - 94.4 FL Mean Corpuscular Hemoglobin 33.0High 27.7 - 32.6 PG Mean Corpuscular Hemoglobin Conc 36.2High 32.4 - 35.7 G/DL Rdwcv 12.2 11.6 - 13.9 % Rdwsd 40.6 36.0 - 46.1 FL Platelet Count 165 154 - 364 THOUS/uL Mean Platelet Volume 9.9 8.7 - 11.7 FL Nucleated Red Blood Cells 0.0 0.0 /100 WBC''S Abs NRBC 0.0 0.0 THOUS/uL Differential Type AUTO Neutrophils 47.2 34.0 - 67.9 % Lymphs 35.2 19.1 - 41.2 % Monocytes 15.5High 6.1 - 12.3 % Eos 0.8Low 0.9 - 7.6 % Basos 1.0 0.2 - 1.5 % Neutrophils Absolute Count 1.8Low 2.7 - 5.8 THOUS/uL Lymphocytes Absolute Count 1.4 1.1 - 3.3 THOUS/uL Monocytes Absolute Count 0.6 0.4 - 0.9 THOUS/uL Eosinophils Absolute Count 0.0Low 0.1 - 0.6 THOUS/uL Basophils Absolute Count 0.0 0.0 - 0.1 THOUS/uL Imm Gran 0.3 0.2 - 0.9 % Abs Imm Gran 0.01 0.0 - 0.1 THOUS/uL
CDC 'Split Type':

Write-up: 4/6/12 ER HPI: 74 y.o. male who presents with complaint of shortness of breath that is worse after eating for 3 weeks. Patient said he had received a his copied vaccine 3 weeks ago. No cough, no chest pain, no abdominal pain nausea vomiting, no palpitations and no fever or chills Shortness of Breath: Started 3 weeks ago and getting worse. Received covid vaccine 3 weeks ago and started then. No cough. Dyspnea on exertion. No fever. Early am he has had runny noses. No inhalers or nebs. Not smoker

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