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This is VAERS ID 1213260

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1213260
VAERS Form:2
Age:65.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-04-07
Onset:2021-04-14
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Blood bilirubin, Blood fibrinogen increased, C-reactive protein increased, Differential white blood cell count normal, Fibrin D dimer increased, Haemoglobin decreased, HIV test negative, International normalised ratio increased, Platelet count normal, White blood cell count normal, Hepatitis B surface antigen negative, Palpable purpura, Metabolic function test, Hepatitis B test negative, Hepatitis C virus test, SARS-CoV-2 test negative

Life Threatening? Yes
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: warfarin
Current Illness: no
Preexisting Conditions: History of Aortic valve replacement
Allergies: gabapentin ibuprofen
Diagnostic Lab Data: PendingBilirubin 3.2. Rest of CMP is normal.White blood cell count 5.5 thousand, hemoglobin 12.5, platelets 186,000, Normal manual differential, fibrinogen 581, INR therapeutic at 2.1, d-dimer 0.72. Blood type O+.SARS COV2 PCR negative HCV Ab and HBV SAg negative,HIV negative. C-reactive protein 83.
CDC 'Split Type':

Write-up: Patient presented to ED on 4/14/2021 with 24 h of progressive painful/pruritic palpable purpura of distal upper and lower extremities. No evidence of additional organ involvement.


Changed on 5/7/2021

VAERS ID: 1213260 Before After
VAERS Form:2
Age:65.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-04-07
Onset:2021-04-14
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Blood bilirubin, Blood fibrinogen increased, C-reactive protein increased, Differential white blood cell count normal, Fibrin D dimer increased, Haemoglobin decreased, HIV test negative, International normalised ratio increased, Platelet count normal, White blood cell count normal, Hepatitis B surface antigen negative, Palpable purpura, Metabolic function test, Hepatitis B test negative, Hepatitis C virus test, SARS-CoV-2 test negative

Life Threatening? Yes
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: warfarin
Current Illness: no
Preexisting Conditions: History of Aortic valve replacement
Allergies: gabapentin ibuprofen ibuprofen
Diagnostic Lab Data: PendingBilirubin 3.2. Rest of CMP is normal.White blood cell count 5.5 thousand, hemoglobin 12.5, platelets 186,000, Normal manual differential, fibrinogen 581, INR therapeutic at 2.1, d-dimer 0.72. Blood type O+.SARS COV2 PCR negative HCV Ab and HBV SAg negative,HIV negative. C-reactive protein 83.
CDC 'Split Type':

Write-up: Patient presented to ED on 4/14/2021 with 24 h of progressive painful/pruritic palpable purpura of distal upper and lower extremities. No evidence of additional organ involvement.


Changed on 5/14/2021

VAERS ID: 1213260 Before After
VAERS Form:2
Age:65.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-04-07
Onset:2021-04-14
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Blood bilirubin, Blood fibrinogen increased, C-reactive protein increased, Differential white blood cell count normal, Fibrin D dimer increased, Haemoglobin decreased, HIV test negative, International normalised ratio increased, Platelet count normal, White blood cell count normal, Hepatitis B surface antigen negative, Palpable purpura, Metabolic function test, Hepatitis B test negative, Hepatitis C virus test, SARS-CoV-2 test negative

Life Threatening? Yes
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: warfarin
Current Illness: no
Preexisting Conditions: History of Aortic valve replacement
Allergies: gabapentin ibuprofen ibuprofen
Diagnostic Lab Data: PendingBilirubin 3.2. Rest of CMP is normal.White blood cell count 5.5 thousand, hemoglobin 12.5, platelets 186,000, Normal manual differential, fibrinogen 581, INR therapeutic at 2.1, d-dimer 0.72. Blood type O+.SARS COV2 PCR negative HCV Ab and HBV SAg negative,HIV negative. C-reactive protein 83.
CDC 'Split Type':

Write-up: Patient presented to ED on 4/14/2021 with 24 h of progressive painful/pruritic palpable purpura of distal upper and lower extremities. No evidence of additional organ involvement.

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