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This is VAERS ID 1227925

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1227925
VAERS Form:2
Age:
Sex:Male
Location:Kansas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Platelet count, Pulmonary embolism, Thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations:
Other Medications:
Current Illness: General physical health deterioration
Preexisting Conditions: Medical History/Concurrent Conditions: Cancer (Unspecified type)
Allergies:
Diagnostic Lab Data: Test Name: Platelet count; Result Unstructured Data: Thrombocytopenia (count unspecified)
CDC 'Split Type': USJNJFOC20210427876

Write-up: SUSPECTED PULMONARY EMBOLISM; THROMBOCYTOPENIA; This spontaneous report received from a health care professional from a state immunization program concerned a 60 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included cancer, and concurrent conditions included overall poor health. The patient received COVID-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown), date of administration was not reported, for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, approximately 24 hours post-vaccination, the patient was taken to the hospital after being found unresponsive. It was suspected that the patient had experienced a pulmonary embolism, resulting in his death. Laboratory results revealed thrombocytopenia. Reportedly, no heparin was used in his treatment. On an unspecified date, the subject died from suspected pulmonary embolism, and had not recovered from thrombocytopenia. An autopsy had not been performed at the time of the report, as it was pending family''s approval. The action taken with COVID-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death, and Other Medically Important Condition).; Sender''s Comments: V0: This is a spontaneous report of a 60-year-old male patient, who died of a suspected pulmonary embolism approximately 24 hours after receipt of the Janssen COVID-19 vaccine. The patient had an unspecified cancer and was described as in overall poor health. He was brought to a hospital, where it was suspected that he had died due to a pulmonary embolism. He was also found to be thrombocytopenic. The patient''s cancer could provide a plausible alternative explanation for the event, although there are insufficient details to make a meaningful medical assessment at this time.; Reported Cause(s) of Death: SUSPECTED PULMONARY EMBOLISM


Changed on 5/7/2021

VAERS ID: 1227925 Before After
VAERS Form:2
Age:
Sex:Male
Location:Kansas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Platelet count, Pulmonary embolism, Thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations:
Other Medications:
Current Illness: General physical health deterioration
Preexisting Conditions: Medical History/Concurrent Conditions: Cancer (Unspecified type)
Allergies:
Diagnostic Lab Data: Test Name: Platelet count; Result Unstructured Data: Thrombocytopenia (count unspecified)
CDC 'Split Type': USJNJFOC20210427876

Write-up: SUSPECTED PULMONARY EMBOLISM; THROMBOCYTOPENIA; This spontaneous report received from a health care professional from a state immunization program concerned a 60 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included cancer, and concurrent conditions included overall poor health. The patient received COVID-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown), date of administration was not reported, for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, approximately 24 hours post-vaccination, the patient was taken to the hospital after being found unresponsive. It was suspected that the patient had experienced a pulmonary embolism, resulting in his death. Laboratory results revealed thrombocytopenia. Reportedly, no heparin was used in his treatment. On an unspecified date, the subject died from suspected pulmonary embolism, and had not recovered from thrombocytopenia. An autopsy had not been performed at the time of the report, as it was pending family''s approval. The action taken with COVID-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death, and Other Medically Important Condition).; Sender''s Comments: V0: This is a spontaneous report of a 60-year-old male patient, who died of a suspected pulmonary embolism approximately 24 hours after receipt of the Janssen COVID-19 vaccine. The patient had an unspecified cancer and was described as in overall poor health. He was brought to a hospital, where it was suspected that he had died due to a pulmonary embolism. He was also found to be thrombocytopenic. The patient''s cancer could provide a plausible alternative explanation for the event, although there are insufficient details to make a meaningful medical assessment at this time.; Reported Cause(s) of Death: SUSPECTED PULMONARY EMBOLISM


Changed on 5/14/2021

VAERS ID: 1227925 Before After
VAERS Form:2
Age:
Sex:Male
Location:Kansas
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Platelet count, Pulmonary embolism, Thrombocytopenia

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:0000-00-00
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? No
Previous Vaccinations:
Other Medications:
Current Illness: General physical health deterioration
Preexisting Conditions: Medical History/Concurrent Conditions: Cancer (Unspecified type)
Allergies:
Diagnostic Lab Data: Test Name: Platelet count; Result Unstructured Data: Thrombocytopenia (count unspecified)
CDC 'Split Type': USJNJFOC20210427876

Write-up: SUSPECTED PULMONARY EMBOLISM; THROMBOCYTOPENIA; This spontaneous report received from a health care professional from a state immunization program concerned a 60 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included cancer, and concurrent conditions included overall poor health. The patient received COVID-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown), date of administration was not reported, for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On an unspecified date, approximately 24 hours post-vaccination, the patient was taken to the hospital after being found unresponsive. It was suspected that the patient had experienced a pulmonary embolism, resulting in his death. Laboratory results revealed thrombocytopenia. Reportedly, no heparin was used in his treatment. On an unspecified date, the subject died from suspected pulmonary embolism, and had not recovered from thrombocytopenia. An autopsy had not been performed at the time of the report, as it was pending family''s approval. The action taken with COVID-19 vaccine ad26.cov2.s was not applicable. This report was serious (Death, and Other Medically Important Condition).; Sender''s Comments: V0: This is a spontaneous report of a 60-year-old male patient, who died of a suspected pulmonary embolism approximately 24 hours after receipt of the Janssen COVID-19 vaccine. The patient had an unspecified cancer and was described as in overall poor health. He was brought to a hospital, where it was suspected that he had died due to a pulmonary embolism. He was also found to be thrombocytopenic. The patient''s cancer could provide a plausible alternative explanation for the event, although there are insufficient details to make a meaningful medical assessment at this time.; Reported Cause(s) of Death: SUSPECTED PULMONARY EMBOLISM

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