National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1229878

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1229878
VAERS Form:2
Age:58.0
Sex:Male
Location:Washington
Vaccinated:2021-03-23
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 RA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Cerebral artery occlusion, Carotid artery occlusion, Carotid artery dissection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-05
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Dissection of the right ICA with occlusion of tthe right ICA, right MCA and portions of A1 segmenet of the ACA


Changed on 5/7/2021

VAERS ID: 1229878 Before After
VAERS Form:2
Age:58.0
Sex:Male
Location:Washington
Vaccinated:2021-03-23
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 RA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Cerebral artery occlusion, Carotid artery occlusion, Carotid artery dissection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-05
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Dissection of the right ICA with occlusion of tthe right ICA, right MCA and portions of A1 segmenet of the ACA


Changed on 5/14/2021

VAERS ID: 1229878 Before After
VAERS Form:2
Age:58.0
Sex:Male
Location:Washington
Vaccinated:2021-03-23
Onset:2021-04-03
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 RA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Cerebral artery occlusion, Carotid artery occlusion, Carotid artery dissection

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-05
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Dissection of the right ICA with occlusion of tthe right ICA, right MCA and portions of A1 segmenet of the ACA

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1229878&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


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