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This is VAERS ID 1195446

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1195446
VAERS Form:2
Age:62.0
Sex:Male
Location:Louisiana
Vaccinated:2021-03-11
Onset:2021-03-18
Submitted:0000-00-00
Entered:2021-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Pulmonary thrombosis, Thrombosis

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Clopidogrel 75 mg., doxepin 25 mg., Furosemide 40 mg., Gabapentin 300 mg., Morphine 30 mg., Pantoprazole 40 mg., Pravastatin 40 mg., Tizanidine 4 mg.,
Current Illness:
Preexisting Conditions: High blood pressure, lumbosacral intervertebral disc,carotid artery disease, chronic bronchitis
Allergies: Flexeril
Diagnostic Lab Data: 3/18/2021
CDC 'Split Type':

Write-up: Blood Clots in legs and lungs


Changed on 5/7/2021

VAERS ID: 1195446 Before After
VAERS Form:2
Age:62.0
Sex:Male
Location:Louisiana
Vaccinated:2021-03-11
Onset:2021-03-18
Submitted:0000-00-00
Entered:2021-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Pulmonary thrombosis, Thrombosis

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Clopidogrel 75 mg., doxepin 25 mg., Furosemide 40 mg., Gabapentin 300 mg., Morphine 30 mg., Pantoprazole 40 mg., Pravastatin 40 mg., Tizanidine 4 mg.,
Current Illness:
Preexisting Conditions: High blood pressure, lumbosacral intervertebral disc,carotid artery disease, chronic bronchitis
Allergies: Flexeril Flexeril
Diagnostic Lab Data: 3/18/2021
CDC 'Split Type':

Write-up: Blood Clots in legs and lungs


Changed on 5/14/2021

VAERS ID: 1195446 Before After
VAERS Form:2
Age:62.0
Sex:Male
Location:Louisiana
Vaccinated:2021-03-11
Onset:2021-03-18
Submitted:0000-00-00
Entered:2021-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Pulmonary thrombosis, Thrombosis

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 4     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Clopidogrel 75 mg., doxepin 25 mg., Furosemide 40 mg., Gabapentin 300 mg., Morphine 30 mg., Pantoprazole 40 mg., Pravastatin 40 mg., Tizanidine 4 mg.,
Current Illness:
Preexisting Conditions: High blood pressure, lumbosacral intervertebral disc,carotid artery disease, chronic bronchitis
Allergies: Flexeril Flexeril
Diagnostic Lab Data: 3/18/2021
CDC 'Split Type':

Write-up: Blood Clots in legs and lungs

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1195446&WAYBACKHISTORY=ON

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