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This is VAERS ID 1212470

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1212470
VAERS Form:2
Age:29.0
Sex:Male
Location:Unknown
Vaccinated:2021-04-01
Onset:2021-04-14
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Pleuritic pain, Pulmonary embolism

Life Threatening? No
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: sertraline
Current Illness: no
Preexisting Conditions: none
Allergies: NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 29yom with no significant medical history was diagnosed by CT with acute pulmonary embolism involving the branch vessel in the right lower lobe 14 days after receiving Johnson & Johnson vaccine. Symptoms of right pleuritic pain began 4 days prior to the diagnosis. Initiated therapy on oral anticoagulants.


Changed on 5/7/2021

VAERS ID: 1212470 Before After
VAERS Form:2
Age:29.0
Sex:Male
Location:Unknown
Vaccinated:2021-04-01
Onset:2021-04-14
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Pleuritic pain, Pulmonary embolism

Life Threatening? No
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: sertraline
Current Illness: no
Preexisting Conditions: none
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 29yom with no significant medical history was diagnosed by CT with acute pulmonary embolism involving the branch vessel in the right lower lobe 14 days after receiving Johnson & Johnson vaccine. Symptoms of right pleuritic pain began 4 days prior to the diagnosis. Initiated therapy on oral anticoagulants.


Changed on 5/14/2021

VAERS ID: 1212470 Before After
VAERS Form:2
Age:29.0
Sex:Male
Location:Unknown
Vaccinated:2021-04-01
Onset:2021-04-14
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Pleuritic pain, Pulmonary embolism

Life Threatening? No
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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: sertraline
Current Illness: no
Preexisting Conditions: none
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: 29yom with no significant medical history was diagnosed by CT with acute pulmonary embolism involving the branch vessel in the right lower lobe 14 days after receiving Johnson & Johnson vaccine. Symptoms of right pleuritic pain began 4 days prior to the diagnosis. Initiated therapy on oral anticoagulants.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1212470&WAYBACKHISTORY=ON

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