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This is VAERS ID 1209778

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1209778
VAERS Form:2
Age:87.0
Sex:Female
Location:New York
Vaccinated:2021-03-12
Onset:2021-03-26
Submitted:0000-00-00
Entered:2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain, Constipation, Nausea, Platelet count decreased, Portal vein thrombosis, Seizure, Vomiting, Computerised tomogram abdomen, Bacteroides bacteraemia, Ultrasound scan abnormal, Scan with contrast normal, Magnetic resonance imaging head normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Senna, Colace, Seroquel, Plavix, Effexor, Lipitor, Insulin (75/25), Vitamin D, Vitamin B12, Nystop powder, Restasis drops, Albuterol HFA, Miralax powder
Current Illness: Abdominal Pain, Nausea, Vomiting, Constipation, Seizure, Portal Vein Thrombosis, platelets at lowest = 125 on 3/28 in setting of heparin subcutaneous
Preexisting Conditions: Prior Stroke, Diabates, Hypertension, Glaucoma, ANxiety, Depression, GERD
Allergies: Lisinopril Sulfa
Diagnostic Lab Data: As above
CDC 'Split Type':

Write-up: Patient was admitted to the hospital 12 days (3/24/21) after vaccine dose administration (3/12/21) sent in for refractory abdominal pain, nausea and vomiting. On admission, a CT Abdomen/Pelvis with contrast was largely unremarkable including reported demonstration of patent portal vein. During the course of the hospitalization the patient developed a portal vein thrombosis visualized on 3/26 by ultrasound. She also received Heparin SQ from 3/27/21 through 4/2/21 but not sent home on anticoagulation. Her course was also complicated by a seizure and Bacteroides bacteremia. MR Brain did not demonstrate thrombosis


Changed on 5/7/2021

VAERS ID: 1209778 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:New York
Vaccinated:2021-03-12
Onset:2021-03-26
Submitted:0000-00-00
Entered:2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain, Constipation, Nausea, Platelet count decreased, Portal vein thrombosis, Seizure, Vomiting, Computerised tomogram abdomen, Bacteroides bacteraemia, Ultrasound scan abnormal, Scan with contrast normal, Magnetic resonance imaging head normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Senna, Colace, Seroquel, Plavix, Effexor, Lipitor, Insulin (75/25), Vitamin D, Vitamin B12, Nystop powder, Restasis drops, Albuterol HFA, Miralax powder
Current Illness: Abdominal Pain, Nausea, Vomiting, Constipation, Seizure, Portal Vein Thrombosis, platelets at lowest = 125 on 3/28 in setting of heparin subcutaneous
Preexisting Conditions: Prior Stroke, Diabates, Hypertension, Glaucoma, ANxiety, Depression, GERD
Allergies: Lisinopril Sulfa Sulfa
Diagnostic Lab Data: As above
CDC 'Split Type':

Write-up: Patient was admitted to the hospital 12 days (3/24/21) after vaccine dose administration (3/12/21) sent in for refractory abdominal pain, nausea and vomiting. On admission, a CT Abdomen/Pelvis with contrast was largely unremarkable including reported demonstration of patent portal vein. During the course of the hospitalization the patient developed a portal vein thrombosis visualized on 3/26 by ultrasound. She also received Heparin SQ from 3/27/21 through 4/2/21 but not sent home on anticoagulation. Her course was also complicated by a seizure and Bacteroides bacteremia. MR Brain did not demonstrate thrombosis


Changed on 5/14/2021

VAERS ID: 1209778 Before After
VAERS Form:2
Age:87.0
Sex:Female
Location:New York
Vaccinated:2021-03-12
Onset:2021-03-26
Submitted:0000-00-00
Entered:2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / UNK LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain, Constipation, Nausea, Platelet count decreased, Portal vein thrombosis, Seizure, Vomiting, Computerised tomogram abdomen, Bacteroides bacteraemia, Ultrasound scan abnormal, Scan with contrast normal, Magnetic resonance imaging head normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 10     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Senna, Colace, Seroquel, Plavix, Effexor, Lipitor, Insulin (75/25), Vitamin D, Vitamin B12, Nystop powder, Restasis drops, Albuterol HFA, Miralax powder
Current Illness: Abdominal Pain, Nausea, Vomiting, Constipation, Seizure, Portal Vein Thrombosis, platelets at lowest = 125 on 3/28 in setting of heparin subcutaneous
Preexisting Conditions: Prior Stroke, Diabates, Hypertension, Glaucoma, ANxiety, Depression, GERD
Allergies: Lisinopril Sulfa Sulfa
Diagnostic Lab Data: As above
CDC 'Split Type':

Write-up: Patient was admitted to the hospital 12 days (3/24/21) after vaccine dose administration (3/12/21) sent in for refractory abdominal pain, nausea and vomiting. On admission, a CT Abdomen/Pelvis with contrast was largely unremarkable including reported demonstration of patent portal vein. During the course of the hospitalization the patient developed a portal vein thrombosis visualized on 3/26 by ultrasound. She also received Heparin SQ from 3/27/21 through 4/2/21 but not sent home on anticoagulation. Her course was also complicated by a seizure and Bacteroides bacteremia. MR Brain did not demonstrate thrombosis

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