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This is VAERS ID 1210787

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1210787
VAERS Form:2
Age:57.0
Sex:Male
Location:Maryland
Vaccinated:2021-03-27
Onset:2021-03-29
Submitted:0000-00-00
Entered:2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / SYR

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain, Antinuclear antibody, Blood fibrinogen, Cardiolipin antibody, Coagulation factor V level normal, Computerised tomogram abnormal, Mesenteric vein thrombosis, Portal vein thrombosis, Splenic vein thrombosis, Protein C, Protein S, Antithrombin III, Haptoglobin, Heparin-induced thrombocytopenia test, Explorative laparotomy, Computerised tomogram abdomen, Pneumatosis intestinalis, Antiphospholipid antibodies, Decreased appetite, Gene mutation identification test negative, Beta-2 glycoprotein antibody, Mechanical ventilation, Portal shunt procedure

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, pantoprazole
Current Illness: Mesenteric lymphadenopathy s/p outpatient laparoscopic mesenteric lymph node biopsy on 3/22. Procedure and recovery were uncomplicated
Preexisting Conditions: HTN, GERD
Allergies: None
Diagnostic Lab Data: CT abdomen/pelvis 3/31 notable for acute thrombosis of the portal, splenic, and superior mesenteric veins Hematology work up negative, including Protein C, protein S, factor V leiden, anti-thrombin 3, JAK2 mutation screen, lupus anticoagulant workup including anti-cardiolipin antibody, anti-phospholipid antibody, lupus anticoagulant antibody, anti-B2-glycoprotein antibody, and ANA screen, fibrinogen and haptoglobin, HIT
CDC 'Split Type':

Write-up: Pt developed abdominal pain and anorexia beginning two days after receiving vaccine dose. Presented to ED and found to have portal vein, SMV and splenic vein thrombosis. Underwent TIPS c/b recurrent thrombosis x 2 and cecal pneumatosis s/p exploratory laparotomy, open abdomen, delayed closure. He was mechanically ventilated and briefly requiring vasopressor support, now extubated and off pressors. Remains inpatient on anticoagulation and TPN. Hematology work-up while inpatient was negative.


Changed on 5/7/2021

VAERS ID: 1210787 Before After
VAERS Form:2
Age:57.0
Sex:Male
Location:Maryland
Vaccinated:2021-03-27
Onset:2021-03-29
Submitted:0000-00-00
Entered:2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / SYR

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain, Antinuclear antibody, Blood fibrinogen, Cardiolipin antibody, Coagulation factor V level normal, Computerised tomogram abnormal, Mesenteric vein thrombosis, Portal vein thrombosis, Splenic vein thrombosis, Protein C, Protein S, Antithrombin III, Haptoglobin, Heparin-induced thrombocytopenia test, Explorative laparotomy, Computerised tomogram abdomen, Pneumatosis intestinalis, Antiphospholipid antibodies, Decreased appetite, Gene mutation identification test negative, Beta-2 glycoprotein antibody, Mechanical ventilation, Portal shunt procedure

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, pantoprazole
Current Illness: Mesenteric lymphadenopathy s/p outpatient laparoscopic mesenteric lymph node biopsy on 3/22. Procedure and recovery were uncomplicated
Preexisting Conditions: HTN, GERD
Allergies: None None
Diagnostic Lab Data: CT abdomen/pelvis 3/31 notable for acute thrombosis of the portal, splenic, and superior mesenteric veins Hematology work up negative, including Protein C, protein S, factor V leiden, anti-thrombin 3, JAK2 mutation screen, lupus anticoagulant workup including anti-cardiolipin antibody, anti-phospholipid antibody, lupus anticoagulant antibody, anti-B2-glycoprotein antibody, and ANA screen, fibrinogen and haptoglobin, HIT
CDC 'Split Type':

Write-up: Pt developed abdominal pain and anorexia beginning two days after receiving vaccine dose. Presented to ED and found to have portal vein, SMV and splenic vein thrombosis. Underwent TIPS c/b recurrent thrombosis x 2 and cecal pneumatosis s/p exploratory laparotomy, open abdomen, delayed closure. He was mechanically ventilated and briefly requiring vasopressor support, now extubated and off pressors. Remains inpatient on anticoagulation and TPN. Hematology work-up while inpatient was negative.


Changed on 5/14/2021

VAERS ID: 1210787 Before After
VAERS Form:2
Age:57.0
Sex:Male
Location:Maryland
Vaccinated:2021-03-27
Onset:2021-03-29
Submitted:0000-00-00
Entered:2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / SYR

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain, Antinuclear antibody, Blood fibrinogen, Cardiolipin antibody, Coagulation factor V level normal, Computerised tomogram abnormal, Mesenteric vein thrombosis, Portal vein thrombosis, Splenic vein thrombosis, Protein C, Protein S, Antithrombin III, Haptoglobin, Heparin-induced thrombocytopenia test, Explorative laparotomy, Computerised tomogram abdomen, Pneumatosis intestinalis, Antiphospholipid antibodies, Decreased appetite, Gene mutation identification test negative, Beta-2 glycoprotein antibody, Mechanical ventilation, Portal shunt procedure

Life Threatening? Yes
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril, pantoprazole
Current Illness: Mesenteric lymphadenopathy s/p outpatient laparoscopic mesenteric lymph node biopsy on 3/22. Procedure and recovery were uncomplicated
Preexisting Conditions: HTN, GERD
Allergies: None None
Diagnostic Lab Data: CT abdomen/pelvis 3/31 notable for acute thrombosis of the portal, splenic, and superior mesenteric veins Hematology work up negative, including Protein C, protein S, factor V leiden, anti-thrombin 3, JAK2 mutation screen, lupus anticoagulant workup including anti-cardiolipin antibody, anti-phospholipid antibody, lupus anticoagulant antibody, anti-B2-glycoprotein antibody, and ANA screen, fibrinogen and haptoglobin, HIT
CDC 'Split Type':

Write-up: Pt developed abdominal pain and anorexia beginning two days after receiving vaccine dose. Presented to ED and found to have portal vein, SMV and splenic vein thrombosis. Underwent TIPS c/b recurrent thrombosis x 2 and cecal pneumatosis s/p exploratory laparotomy, open abdomen, delayed closure. He was mechanically ventilated and briefly requiring vasopressor support, now extubated and off pressors. Remains inpatient on anticoagulation and TPN. Hematology work-up while inpatient was negative.

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