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This is VAERS ID 1199203

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1199203
VAERS Form:2
Age:51.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-03-19
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 AR / IM

Administered by: Other      Purchased by: ??
Symptoms: Atelectasis, Pulmonary embolism, Computerised tomogram thorax abnormal, Pulmonary arterial hypertension, Limb mass

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Clindamycin lotion topical TID
Current Illness:
Preexisting Conditions: Possibly undiagnosed obstructive sleep apnea
Allergies: Benzocaine, Aspirin
Diagnostic Lab Data: CTA Chest, PE Protocol on 04/09/2021 IMPRESSION: Large pulmonary embolism in the right main pulmonary artery, right upper, middle and lower lobe pulmonary artery segmental branches and left lingular subsegmental branches. There is associated pulmonary artery hypertension with pulmonary artery measuring up to 3.6 cm. Low lung volumes. Minimal atelectasis in the left lower lobe. No consolidation.
CDC 'Split Type':

Write-up: Patient had a large pulmonary embolism 3 weeks after receiving the vaccine. Unclear if vaccination was the cause, but giving the timing we are reporting it. The health care proxy also noted some palpable masses on distal L extremity, unclear if related to vaccine or what these are.


Changed on 5/7/2021

VAERS ID: 1199203 Before After
VAERS Form:2
Age:51.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-03-19
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 AR / IM

Administered by: Other      Purchased by: ??
Symptoms: Atelectasis, Pulmonary embolism, Computerised tomogram thorax abnormal, Pulmonary arterial hypertension, Limb mass

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Clindamycin lotion topical TID
Current Illness:
Preexisting Conditions: Possibly undiagnosed obstructive sleep apnea
Allergies: Benzocaine, Aspirin Aspirin
Diagnostic Lab Data: CTA Chest, PE Protocol on 04/09/2021 IMPRESSION: Large pulmonary embolism in the right main pulmonary artery, right upper, middle and lower lobe pulmonary artery segmental branches and left lingular subsegmental branches. There is associated pulmonary artery hypertension with pulmonary artery measuring up to 3.6 cm. Low lung volumes. Minimal atelectasis in the left lower lobe. No consolidation.
CDC 'Split Type':

Write-up: Patient had a large pulmonary embolism 3 weeks after receiving the vaccine. Unclear if vaccination was the cause, but giving the timing we are reporting it. The health care proxy also noted some palpable masses on distal L extremity, unclear if related to vaccine or what these are.


Changed on 5/14/2021

VAERS ID: 1199203 Before After
VAERS Form:2
Age:51.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-03-19
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 AR / IM

Administered by: Other      Purchased by: ??
Symptoms: Atelectasis, Pulmonary embolism, Computerised tomogram thorax abnormal, Pulmonary arterial hypertension, Limb mass

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Clindamycin lotion topical TID
Current Illness:
Preexisting Conditions: Possibly undiagnosed obstructive sleep apnea
Allergies: Benzocaine, Aspirin Aspirin
Diagnostic Lab Data: CTA Chest, PE Protocol on 04/09/2021 IMPRESSION: Large pulmonary embolism in the right main pulmonary artery, right upper, middle and lower lobe pulmonary artery segmental branches and left lingular subsegmental branches. There is associated pulmonary artery hypertension with pulmonary artery measuring up to 3.6 cm. Low lung volumes. Minimal atelectasis in the left lower lobe. No consolidation.
CDC 'Split Type':

Write-up: Patient had a large pulmonary embolism 3 weeks after receiving the vaccine. Unclear if vaccination was the cause, but giving the timing we are reporting it. The health care proxy also noted some palpable masses on distal L extremity, unclear if related to vaccine or what these are.

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