National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1221058

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1221058
VAERS Form:2
Age:37.0
Sex:Male
Location:North Carolina
Vaccinated:2021-03-11
Onset:2021-03-22
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN MVP-COVID-19 18 / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Anaemia, Angiogram pulmonary abnormal, Antinuclear antibody, Asthenia, Biopsy bone marrow normal, Blood fibrinogen increased, Blood glucose increased, Blood immunoglobulin G increased, Bronchoscopy normal, Chest pain, Fatigue, Intensive care, Leukocytosis, Myocarditis, Pleural effusion, Pleuritic pain, Polychromasia, Pulmonary oedema, Pyrexia, Respiratory distress, Serum ferritin increased, Shock, Upper respiratory tract infection, White blood cell count increased, Ejection fraction decreased, Platelet count increased, Neutrophil percentage increased, Blood smear test abnormal, Histone antibody negative, Antineutrophil cytoplasmic antibody negative, Echocardiogram abnormal, Bilevel positive airway pressure, Ehrlichia test, Interleukin-2 receptor assay, Magnetic resonance imaging abnormal, Magnetic resonance imaging heart

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)? No
Hospitalized? Yes, days: 25     Extended hospital stay? No
Previous Vaccinations:
Other Medications: amoxicillin 400 mg/5mL (take 10 mL by mouth twice a day) ibuprofen 800 mg (every 8 hours as needed) insulin glargine (40 units at bedtime daily) insulin lispro 100 unit/mL (injection 12 units subcutaneously 3 time a day)
Current Illness: One month prior to vaccination pt was admitted to the hospital for altered mental status, new onset type 1 diabetes, dka, and pancreatitis. At this time pt was also found to have symptoms of shock, AKI, and hyperlipidemia.
Preexisting Conditions: diabetes (unable to determine type)
Allergies: no known allergies
Diagnostic Lab Data: Ferritin: (4/13) 11,844; (3/31) $g 40,000 MRI cardiac: (3/26) LVEF 45% supported myocarditis Echo: (3/22) EF 40-45%; (3/27) 60-65%; (4/9) 50-55% Anaplasma phagocytophilum abs: (4/3) negative proteinase 3-Ab: (4/5) negative Anti histone antibodies: (4/3) negative Anti- scleroderma: (4/5) negative IL-2 RAlpha: (4/1) 6150 CTA: (3/28) pleural effusions, negative for PE WBC: (4/15) 33.43 PLT: (4/15) 782 Neutrophil %: (4/15) 92% Polychromasia: (4/15) 2+ Fibrinogen: (4/13) 738
CDC 'Split Type':

Write-up: Pt admitted to the ICU on 3/22/21 w/ pleuritic chest pain and shock requiring vasopressors. At time of admission pt had been taking antibiotics for an upper respiratory infection for 3 days. Echo Lv 40-45% upon admission. Pt was determined to have myopericarditis. On 3/24/21 pt was transferred to the cardiac intermediate unit. Endocrine consulted while in the cardiac intermediate unit to control his elevated blood sugars- endocrine team unable to determine if blood sugar is type 1 or type 2. on 3/27/21 pt went into respiratory distress required bipap & high flow nasal cannula and had a fever. Pulmonary consulted at this time- determined to be related to pulmonary edema and not a PE positive for pleural effusion. ID has been negative up to this point. 4/9/21 pt transferred to internal medicine service for work up for fever of unknown origin and continued management. Rheumatology consulted for leukocytosis, anemia, and elevated IgG. Ruled out connective tissue disease, stills disease, and vasculitis. Histoplasma was borderline positive pt has had recent bat exposure. Bone marrow biopsy done on 4/13/2021, ruled out HLH. Bronch done 4/15 to assess for TB, histoplasma, negative results so far. As of 4/15 no recommendations from ID and patient continues to look weaker/fatigued and spikes fever.


Changed on 5/7/2021

VAERS ID: 1221058 Before After
VAERS Form:2
Age:37.0
Sex:Male
Location:North Carolina
Vaccinated:2021-03-11
Onset:2021-03-22
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN MVP-COVID-19 18 / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Anaemia, Angiogram pulmonary abnormal, Antinuclear antibody, Asthenia, Biopsy bone marrow normal, Blood fibrinogen increased, Blood glucose increased, Blood immunoglobulin G increased, Bronchoscopy normal, Chest pain, Fatigue, Intensive care, Leukocytosis, Myocarditis, Pleural effusion, Pleuritic pain, Polychromasia, Pulmonary oedema, Pyrexia, Respiratory distress, Serum ferritin increased, Shock, Upper respiratory tract infection, White blood cell count increased, Ejection fraction decreased, Platelet count increased, Neutrophil percentage increased, Blood smear test abnormal, Histone antibody negative, Antineutrophil cytoplasmic antibody negative, Echocardiogram abnormal, Bilevel positive airway pressure, Ehrlichia test, Interleukin-2 receptor assay, Magnetic resonance imaging abnormal, Magnetic resonance imaging heart

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)? No
Hospitalized? Yes, days: 25     Extended hospital stay? No
Previous Vaccinations:
Other Medications: amoxicillin 400 mg/5mL (take 10 mL by mouth twice a day) ibuprofen 800 mg (every 8 hours as needed) insulin glargine (40 units at bedtime daily) insulin lispro 100 unit/mL (injection 12 units subcutaneously 3 time a day)
Current Illness: One month prior to vaccination pt was admitted to the hospital for altered mental status, new onset type 1 diabetes, dka, and pancreatitis. At this time pt was also found to have symptoms of shock, AKI, and hyperlipidemia.
Preexisting Conditions: diabetes (unable to determine type)
Allergies: no known allergies allergies
Diagnostic Lab Data: Ferritin: (4/13) 11,844; (3/31) $g 40,000 MRI cardiac: (3/26) LVEF 45% supported myocarditis Echo: (3/22) EF 40-45%; (3/27) 60-65%; (4/9) 50-55% Anaplasma phagocytophilum abs: (4/3) negative proteinase 3-Ab: (4/5) negative Anti histone antibodies: (4/3) negative Anti- scleroderma: (4/5) negative IL-2 RAlpha: (4/1) 6150 CTA: (3/28) pleural effusions, negative for PE WBC: (4/15) 33.43 PLT: (4/15) 782 Neutrophil %: (4/15) 92% Polychromasia: (4/15) 2+ Fibrinogen: (4/13) 738
CDC 'Split Type':

Write-up: Pt admitted to the ICU on 3/22/21 w/ pleuritic chest pain and shock requiring vasopressors. At time of admission pt had been taking antibiotics for an upper respiratory infection for 3 days. Echo Lv 40-45% upon admission. Pt was determined to have myopericarditis. On 3/24/21 pt was transferred to the cardiac intermediate unit. Endocrine consulted while in the cardiac intermediate unit to control his elevated blood sugars- endocrine team unable to determine if blood sugar is type 1 or type 2. on 3/27/21 pt went into respiratory distress required bipap & high flow nasal cannula and had a fever. Pulmonary consulted at this time- determined to be related to pulmonary edema and not a PE positive for pleural effusion. ID has been negative up to this point. 4/9/21 pt transferred to internal medicine service for work up for fever of unknown origin and continued management. Rheumatology consulted for leukocytosis, anemia, and elevated IgG. Ruled out connective tissue disease, stills disease, and vasculitis. Histoplasma was borderline positive pt has had recent bat exposure. Bone marrow biopsy done on 4/13/2021, ruled out HLH. Bronch done 4/15 to assess for TB, histoplasma, negative results so far. As of 4/15 no recommendations from ID and patient continues to look weaker/fatigued and spikes fever.


Changed on 5/14/2021

VAERS ID: 1221058 Before After
VAERS Form:2
Age:37.0
Sex:Male
Location:North Carolina
Vaccinated:2021-03-11
Onset:2021-03-22
Submitted:0000-00-00
Entered:2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN MVP-COVID-19 18 / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Anaemia, Angiogram pulmonary abnormal, Antinuclear antibody, Asthenia, Biopsy bone marrow normal, Blood fibrinogen increased, Blood glucose increased, Blood immunoglobulin G increased, Bronchoscopy normal, Chest pain, Fatigue, Intensive care, Leukocytosis, Myocarditis, Pleural effusion, Pleuritic pain, Polychromasia, Pulmonary oedema, Pyrexia, Respiratory distress, Serum ferritin increased, Shock, Upper respiratory tract infection, White blood cell count increased, Ejection fraction decreased, Platelet count increased, Neutrophil percentage increased, Blood smear test abnormal, Histone antibody negative, Antineutrophil cytoplasmic antibody negative, Echocardiogram abnormal, Bilevel positive airway pressure, Ehrlichia test, Interleukin-2 receptor assay, Magnetic resonance imaging abnormal, Magnetic resonance imaging heart

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)? No
Hospitalized? Yes, days: 25     Extended hospital stay? No
Previous Vaccinations:
Other Medications: amoxicillin 400 mg/5mL (take 10 mL by mouth twice a day) ibuprofen 800 mg (every 8 hours as needed) insulin glargine (40 units at bedtime daily) insulin lispro 100 unit/mL (injection 12 units subcutaneously 3 time a day)
Current Illness: One month prior to vaccination pt was admitted to the hospital for altered mental status, new onset type 1 diabetes, dka, and pancreatitis. At this time pt was also found to have symptoms of shock, AKI, and hyperlipidemia.
Preexisting Conditions: diabetes (unable to determine type)
Allergies: no known allergies allergies
Diagnostic Lab Data: Ferritin: (4/13) 11,844; (3/31) $g 40,000 MRI cardiac: (3/26) LVEF 45% supported myocarditis Echo: (3/22) EF 40-45%; (3/27) 60-65%; (4/9) 50-55% Anaplasma phagocytophilum abs: (4/3) negative proteinase 3-Ab: (4/5) negative Anti histone antibodies: (4/3) negative Anti- scleroderma: (4/5) negative IL-2 RAlpha: (4/1) 6150 CTA: (3/28) pleural effusions, negative for PE WBC: (4/15) 33.43 PLT: (4/15) 782 Neutrophil %: (4/15) 92% Polychromasia: (4/15) 2+ Fibrinogen: (4/13) 738
CDC 'Split Type':

Write-up: Pt admitted to the ICU on 3/22/21 w/ pleuritic chest pain and shock requiring vasopressors. At time of admission pt had been taking antibiotics for an upper respiratory infection for 3 days. Echo Lv 40-45% upon admission. Pt was determined to have myopericarditis. On 3/24/21 pt was transferred to the cardiac intermediate unit. Endocrine consulted while in the cardiac intermediate unit to control his elevated blood sugars- endocrine team unable to determine if blood sugar is type 1 or type 2. on 3/27/21 pt went into respiratory distress required bipap & high flow nasal cannula and had a fever. Pulmonary consulted at this time- determined to be related to pulmonary edema and not a PE positive for pleural effusion. ID has been negative up to this point. 4/9/21 pt transferred to internal medicine service for work up for fever of unknown origin and continued management. Rheumatology consulted for leukocytosis, anemia, and elevated IgG. Ruled out connective tissue disease, stills disease, and vasculitis. Histoplasma was borderline positive pt has had recent bat exposure. Bone marrow biopsy done on 4/13/2021, ruled out HLH. Bronch done 4/15 to assess for TB, histoplasma, negative results so far. As of 4/15 no recommendations from ID and patient continues to look weaker/fatigued and spikes fever.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1221058&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166