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This is VAERS ID 1190592

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1190592
VAERS Form:2
Age:51.0
Sex:Male
Location:Rhode Island
Vaccinated:2021-03-12
Onset:2021-03-29
Submitted:0000-00-00
Entered:2021-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Fibrin D dimer increased, Pulmonary embolism

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Sertraline 100 MG - 1/day LisinopriL 10 MG - 1/day Adderall XR 30 MG - 1/day Multi Vitamin
Current Illness: None
Preexisting Conditions: Asthma - mild
Allergies: None
Diagnostic Lab Data: D Dimer 3/31/2021 Value: 629
CDC 'Split Type':

Write-up: Bilateral Pulmonary Embolism


Changed on 5/7/2021

VAERS ID: 1190592 Before After
VAERS Form:2
Age:51.0
Sex:Male
Location:Rhode Island
Vaccinated:2021-03-12
Onset:2021-03-29
Submitted:0000-00-00
Entered:2021-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Fibrin D dimer increased, Pulmonary embolism

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Sertraline 100 MG - 1/day LisinopriL 10 MG - 1/day Adderall XR 30 MG - 1/day Multi Vitamin
Current Illness: None
Preexisting Conditions: Asthma - mild
Allergies: None None
Diagnostic Lab Data: D Dimer 3/31/2021 Value: 629
CDC 'Split Type':

Write-up: Bilateral Pulmonary Embolism


Changed on 5/14/2021

VAERS ID: 1190592 Before After
VAERS Form:2
Age:51.0
Sex:Male
Location:Rhode Island
Vaccinated:2021-03-12
Onset:2021-03-29
Submitted:0000-00-00
Entered:2021-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Fibrin D dimer increased, Pulmonary embolism

Life Threatening? Yes
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Sertraline 100 MG - 1/day LisinopriL 10 MG - 1/day Adderall XR 30 MG - 1/day Multi Vitamin
Current Illness: None
Preexisting Conditions: Asthma - mild
Allergies: None None
Diagnostic Lab Data: D Dimer 3/31/2021 Value: 629
CDC 'Split Type':

Write-up: Bilateral Pulmonary Embolism

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1190592&WAYBACKHISTORY=ON

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