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This is VAERS ID 1233515

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1233515
VAERS Form:2
Age:76.0
Sex:Male
Location:New York
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chills, Seizure

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril 5mg Levetiracetam 75mgx4 Amlodipine 10g Gabapentin 600 mg Folic Acid 1mg Hydralazine 25mgx2 omeprazole 20mg Calcium 600-200 Thiamine 100mg OTC : Vitamin C 1000mg
Current Illness: no issues at time of vaccine
Preexisting Conditions: High Blood pressure pre diabetic seizure disorder high cholesterol
Allergies: nka
Diagnostic Lab Data: UNKOWN
CDC 'Split Type':

Write-up: Patient starting feeling chills on Sunday, patient stayed home then had a seizure 4-12-21. They were admitted to the hospital on the evening/ night of 4-12-21 . Still in hospital as of 4-20-21.


Changed on 5/7/2021

VAERS ID: 1233515 Before After
VAERS Form:2
Age:76.0
Sex:Male
Location:New York
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chills, Seizure

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril 5mg Levetiracetam 75mgx4 Amlodipine 10g Gabapentin 600 mg Folic Acid 1mg Hydralazine 25mgx2 omeprazole 20mg Calcium 600-200 Thiamine 100mg OTC : Vitamin C 1000mg
Current Illness: no issues at time of vaccine
Preexisting Conditions: High Blood pressure pre diabetic seizure disorder high cholesterol
Allergies: nka nka
Diagnostic Lab Data: UNKOWN
CDC 'Split Type':

Write-up: Patient starting feeling chills on Sunday, patient stayed home then had a seizure 4-12-21. They were admitted to the hospital on the evening/ night of 4-12-21 . Still in hospital as of 4-20-21.


Changed on 5/14/2021

VAERS ID: 1233515 Before After
VAERS Form:2
Age:76.0
Sex:Male
Location:New York
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chills, Seizure

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril 5mg Levetiracetam 75mgx4 Amlodipine 10g Gabapentin 600 mg Folic Acid 1mg Hydralazine 25mgx2 omeprazole 20mg Calcium 600-200 Thiamine 100mg OTC : Vitamin C 1000mg
Current Illness: no issues at time of vaccine
Preexisting Conditions: High Blood pressure pre diabetic seizure disorder high cholesterol
Allergies: nka nka
Diagnostic Lab Data: UNKOWN
CDC 'Split Type':

Write-up: Patient starting feeling chills on Sunday, patient stayed home then had a seizure 4-12-21. They were admitted to the hospital on the evening/ night of 4-12-21 . Still in hospital as of 4-20-21.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1233515&WAYBACKHISTORY=ON


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