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This is VAERS ID 1213078

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1213078
VAERS Form:2
Age:63.0
Sex:Male
Location:Louisiana
Vaccinated:2021-04-12
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Blood creatine normal, Blood culture, Blood lactic acid, Blood sodium decreased, Blood urea normal, C-reactive protein increased, Chills, Culture urine, Diarrhoea, Dysuria, Headache, Hyponatraemia, Leukocytosis, Nausea, Pyrexia, Red blood cells urine positive, Urine abnormality, Vomiting, White blood cell count increased, White blood cells urine positive, Red blood cell sedimentation rate increased, Nitrite urine present, Bacterial test positive, Urine analysis abnormal, Procalcitonin increased, Acute kidney injury

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:
Current Illness:
Preexisting Conditions: DM, thyroid disease
Allergies: CLINDAMYCIN; HYDROCODONE-ACETAMINOPHEN; ROFECOXIB
Diagnostic Lab Data: In the emergency room febrile 107.5? blood pressure 103/56, HR 135, RR 20, 100% on RA. His labs notable for leukocytosis 18.4, BUN/Cr 13/1.2, hyponatremia 132 , elevated infection markers CRP 260, ESR 49 and Procal 9.6. Lactic acid 1.8. UA cloudy with +ve nitrate. Urine microscopy RBC$g36, WBC$g100 and many bacteria. Blood and urine cultures obtained. In ED received Vancomycin and ceftriaxone and 1 L of RL
CDC 'Split Type':

Write-up: Pt received the J&J vaccine on Monday 4/12 around 10 am. Reports onset of diarrhea mon night, frequent episodes. Then Tuesday 4/13 developed dysuria, fever/chills, headache, nausea, vomiting. Presented to ED 4/14 and admitted to hospital medicine with acute kidney injury.


Changed on 5/7/2021

VAERS ID: 1213078 Before After
VAERS Form:2
Age:63.0
Sex:Male
Location:Louisiana
Vaccinated:2021-04-12
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Blood creatine normal, Blood culture, Blood lactic acid, Blood sodium decreased, Blood urea normal, C-reactive protein increased, Chills, Culture urine, Diarrhoea, Dysuria, Headache, Hyponatraemia, Leukocytosis, Nausea, Pyrexia, Red blood cells urine positive, Urine abnormality, Vomiting, White blood cell count increased, White blood cells urine positive, Red blood cell sedimentation rate increased, Nitrite urine present, Bacterial test positive, Urine analysis abnormal, Procalcitonin increased, Acute kidney injury

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:
Current Illness:
Preexisting Conditions: DM, thyroid disease
Allergies: CLINDAMYCIN; HYDROCODONE-ACETAMINOPHEN; ROFECOXIB ROFECOXIB
Diagnostic Lab Data: In the emergency room febrile 107.5? 107.5 blood pressure 103/56, HR 135, RR 20, 100% on RA. His labs notable for leukocytosis 18.4, BUN/Cr 13/1.2, hyponatremia 132 , elevated infection markers CRP 260, ESR 49 and Procal 9.6. Lactic acid 1.8. UA cloudy with +ve nitrate. Urine microscopy RBC$g36, WBC$g100 and many bacteria. Blood and urine cultures obtained. In ED received Vancomycin and ceftriaxone and 1 L of RL
CDC 'Split Type':

Write-up: Pt received the J&J vaccine on Monday 4/12 around 10 am. Reports onset of diarrhea mon night, frequent episodes. Then Tuesday 4/13 developed dysuria, fever/chills, headache, nausea, vomiting. Presented to ED 4/14 and admitted to hospital medicine with acute kidney injury.


Changed on 5/14/2021

VAERS ID: 1213078 Before After
VAERS Form:2
Age:63.0
Sex:Male
Location:Louisiana
Vaccinated:2021-04-12
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Blood creatine normal, Blood culture, Blood lactic acid, Blood sodium decreased, Blood urea normal, C-reactive protein increased, Chills, Culture urine, Diarrhoea, Dysuria, Headache, Hyponatraemia, Leukocytosis, Nausea, Pyrexia, Red blood cells urine positive, Urine abnormality, Vomiting, White blood cell count increased, White blood cells urine positive, Red blood cell sedimentation rate increased, Nitrite urine present, Bacterial test positive, Urine analysis abnormal, Procalcitonin increased, Acute kidney injury

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:
Current Illness:
Preexisting Conditions: DM, thyroid disease
Allergies: CLINDAMYCIN; HYDROCODONE-ACETAMINOPHEN; ROFECOXIB ROFECOXIB
Diagnostic Lab Data: In the emergency room febrile 107.5 107.5? blood pressure 103/56, HR 135, RR 20, 100% on RA. His labs notable for leukocytosis 18.4, BUN/Cr 13/1.2, hyponatremia 132 , elevated infection markers CRP 260, ESR 49 and Procal 9.6. Lactic acid 1.8. UA cloudy with +ve nitrate. Urine microscopy RBC$g36, WBC$g100 and many bacteria. Blood and urine cultures obtained. In ED received Vancomycin and ceftriaxone and 1 L of RL
CDC 'Split Type':

Write-up: Pt received the J&J vaccine on Monday 4/12 around 10 am. Reports onset of diarrhea mon night, frequent episodes. Then Tuesday 4/13 developed dysuria, fever/chills, headache, nausea, vomiting. Presented to ED 4/14 and admitted to hospital medicine with acute kidney injury.

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