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This is VAERS ID 1228903

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1228903
VAERS Form:2
Age:75.0
Sex:Male
Location:California
Vaccinated:2021-04-06
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cerebral haemorrhage, Angiogram cerebral, Computerised tomogram head, Cerebral venous sinus thrombosis, Magnetic resonance imaging head

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-10
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol amiodarone asa digoxin diltiazem esomeprazole heparin sq ipratropium lactulose ativan metoprolol seroquel
Current Illness: covid19
Preexisting Conditions: rheumatoid arthritis gibleed afib hx cva hx recurrent uti
Allergies: none
Diagnostic Lab Data: ct and cta head 4/9/21 mri brain 4/9/21
CDC 'Split Type':

Write-up: patient had massive intracerebral hemorrhage 3 days after vaccination. family claims patient was doing well until vaccination. there is a suspicion that patient might have had sinus venous thrombosis that lead to the the ICH.


Changed on 5/7/2021

VAERS ID: 1228903 Before After
VAERS Form:2
Age:75.0
Sex:Male
Location:California
Vaccinated:2021-04-06
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cerebral haemorrhage, Angiogram cerebral, Computerised tomogram head, Cerebral venous sinus thrombosis, Magnetic resonance imaging head

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-10
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol amiodarone asa digoxin diltiazem esomeprazole heparin sq ipratropium lactulose ativan metoprolol seroquel
Current Illness: covid19
Preexisting Conditions: rheumatoid arthritis gibleed afib hx cva hx recurrent uti
Allergies: none none
Diagnostic Lab Data: ct and cta head 4/9/21 mri brain 4/9/21
CDC 'Split Type':

Write-up: patient had massive intracerebral hemorrhage 3 days after vaccination. family claims patient was doing well until vaccination. there is a suspicion that patient might have had sinus venous thrombosis that lead to the the ICH.


Changed on 5/14/2021

VAERS ID: 1228903 Before After
VAERS Form:2
Age:75.0
Sex:Male
Location:California
Vaccinated:2021-04-06
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Cerebral haemorrhage, Angiogram cerebral, Computerised tomogram head, Cerebral venous sinus thrombosis, Magnetic resonance imaging head

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-10
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: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol amiodarone asa digoxin diltiazem esomeprazole heparin sq ipratropium lactulose ativan metoprolol seroquel
Current Illness: covid19
Preexisting Conditions: rheumatoid arthritis gibleed afib hx cva hx recurrent uti
Allergies: none none
Diagnostic Lab Data: ct and cta head 4/9/21 mri brain 4/9/21
CDC 'Split Type':

Write-up: patient had massive intracerebral hemorrhage 3 days after vaccination. family claims patient was doing well until vaccination. there is a suspicion that patient might have had sinus venous thrombosis that lead to the the ICH.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1228903&WAYBACKHISTORY=ON

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