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This is VAERS ID 1233697

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1233697
VAERS Form:2
Age:56.0
Sex:Male
Location:Colorado
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 201A21A / 1 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Ageusia, Anosmia, Asthma, Blood albumin decreased, Blood creatine phosphokinase increased, Blood creatinine increased, Blood glucose increased, Blood sodium decreased, Chest discomfort, Chest pain, Chest X-ray normal, Chills, Condition aggravated, Diabetes mellitus, Diarrhoea, Differential white blood cell count normal, Dyspnoea, Electrocardiogram normal, Fibrin D dimer normal, Full blood count normal, Glycosylated haemoglobin increased, Headache, Hypoglycaemia, Hypoxia, Lung infiltration, Myalgia, Nausea, Protein total decreased, Pyrexia, Tachycardia, Tachypnoea, Vomiting, Troponin increased, Troponin T increased, Echocardiogram abnormal, Metabolic function test, Coagulation test normal, Influenza A virus test negative, Influenza B virus test, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
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)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cozaar, Norvasc, HCTZ, Lipitor, NovoLIN R, Lantis
Current Illness:
Preexisting Conditions: ASTHMA, CHRONIC KIDNEY DISEASE, DIABETES, HYPERTENSION, TOBACCO ABUSE DX OF COVID-19 15 APRIL 21.
Allergies: NKDA
Diagnostic Lab Data: 4/15/21 IN ED Port CXR - NEGATIVE, on discussion with Radiologist, subtle focal infiltrate consistent with COVID infiltrates, per ED note. CBC unremarkable; CMP elevated glucose, Elevated Troponin, Creatine Kinase Elevated, D-Dimer within normal range, EKG unremarkable, Influenza A & B negative, COVID 19 Positive, Coag panel within normal limits 4/16/21 CXR - Normal, Glucose - at 1720 374, at 2,225 338 , Troponin T - Elevated21.43 (Ref Range 19), Hemaglobin A1C 13.3 CMP Creatinine 1.36, Sodium low at 131, Glucose 258, D-Dimer within normal limits, CBC unremarkable, 4/17/21 Glucose 47 @ 1720, CMP W/GFR Glucose 43 @ 0500, CBC/W/Diff unremarkable. 4/18/21 Glucose @0215 55 CBC W/Diff unremarkable, CMP@ 0827 Albumin low, Creatinine high, glucose 131, protein low, sodium low, 4/19/21 Echocardiogram: There is an echodensity in the right atrium which measures 1 cm x 1 cm best appreciated in apical four-chamber imaging. This may represent a prominent crista terminalis ridge but recommended further imaging such as cardiac MRI (given acute COVID 19 infection) forfurther evalaution. CBC w/ Diff unremarkable, CMP creatinine high, glucose high, proien low, sodium low.
CDC 'Split Type':

Write-up: Patient received Jassen vaccine 4/10/21. 4/11/21 began with symptoms of fever, headache, chills, nausea, vomiting, and diarrhea, loss of taste and smell. 4/15/21 he presented to ED with symptoms of fever, chest pain and pressure, shortness o breath, myalgias, headache, tachypnea, tachycardia, hypoxia. Was given IV Decadron, DuoNeb and albuerol in ED. Inprovment seen, but patient continued with tachypnea and difficulty breathing. He was admitted to ED with a diagnosis of COVID 19 , asthma exacerbation and elevated Troponin at 31.52 (Ref Range 19) . During admission, glucose levels were labile, requiring adjustment to routine insulin regimen and Glucovance for hypoglycemia. An Echocardiogram was ordered due to elevated Troponin levels on admission. Echocardiogram 4/19/21 showed a density in the right atrium. Cardiology recommended a cardiac MRI. Patient was transfered to Hospital 4/19/21 for elevated care and evaluation, with diagnosis of


Changed on 5/7/2021

VAERS ID: 1233697 Before After
VAERS Form:2
Age:56.0
Sex:Male
Location:Colorado
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 201A21A / 1 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Ageusia, Anosmia, Asthma, Blood albumin decreased, Blood creatine phosphokinase increased, Blood creatinine increased, Blood glucose increased, Blood sodium decreased, Chest discomfort, Chest pain, Chest X-ray normal, Chills, Condition aggravated, Diabetes mellitus, Diarrhoea, Differential white blood cell count normal, Dyspnoea, Electrocardiogram normal, Fibrin D dimer normal, Full blood count normal, Glycosylated haemoglobin increased, Headache, Hypoglycaemia, Hypoxia, Lung infiltration, Myalgia, Nausea, Protein total decreased, Pyrexia, Tachycardia, Tachypnoea, Vomiting, Troponin increased, Troponin T increased, Echocardiogram abnormal, Metabolic function test, Coagulation test normal, Influenza A virus test negative, Influenza B virus test, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
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)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cozaar, Norvasc, HCTZ, Lipitor, NovoLIN R, Lantis
Current Illness:
Preexisting Conditions: ASTHMA, CHRONIC KIDNEY DISEASE, DIABETES, HYPERTENSION, TOBACCO ABUSE DX OF COVID-19 15 APRIL 21.
Allergies: NKDA NKDA
Diagnostic Lab Data: 4/15/21 IN ED Port CXR - NEGATIVE, on discussion with Radiologist, subtle focal infiltrate consistent with COVID infiltrates, per ED note. CBC unremarkable; CMP elevated glucose, Elevated Troponin, Creatine Kinase Elevated, D-Dimer within normal range, EKG unremarkable, Influenza A & B negative, COVID 19 Positive, Coag panel within normal limits 4/16/21 CXR - Normal, Glucose - at 1720 374, at 2,225 338 , Troponin T - Elevated21.43 (Ref Range 19), Hemaglobin A1C 13.3 CMP Creatinine 1.36, Sodium low at 131, Glucose 258, D-Dimer within normal limits, CBC unremarkable, 4/17/21 Glucose 47 @ 1720, CMP W/GFR Glucose 43 @ 0500, CBC/W/Diff unremarkable. 4/18/21 Glucose @0215 55 CBC W/Diff unremarkable, CMP@ 0827 Albumin low, Creatinine high, glucose 131, protein low, sodium low, 4/19/21 Echocardiogram: There is an echodensity in the right atrium which measures 1 cm x 1 cm best appreciated in apical four-chamber imaging. This may represent a prominent crista terminalis ridge but recommended further imaging such as cardiac MRI (given acute COVID 19 infection) forfurther evalaution. CBC w/ Diff unremarkable, CMP creatinine high, glucose high, proien low, sodium low.
CDC 'Split Type':

Write-up: Patient received Jassen vaccine 4/10/21. 4/11/21 began with symptoms of fever, headache, chills, nausea, vomiting, and diarrhea, loss of taste and smell. 4/15/21 he presented to ED with symptoms of fever, chest pain and pressure, shortness o breath, myalgias, headache, tachypnea, tachycardia, hypoxia. Was given IV Decadron, DuoNeb and albuerol in ED. Inprovment seen, but patient continued with tachypnea and difficulty breathing. He was admitted to ED with a diagnosis of COVID 19 , asthma exacerbation and elevated Troponin at 31.52 (Ref Range 19) . During admission, glucose levels were labile, requiring adjustment to routine insulin regimen and Glucovance for hypoglycemia. An Echocardiogram was ordered due to elevated Troponin levels on admission. Echocardiogram 4/19/21 showed a density in the right atrium. Cardiology recommended a cardiac MRI. Patient was transfered to Hospital 4/19/21 for elevated care and evaluation, with diagnosis of


Changed on 5/14/2021

VAERS ID: 1233697 Before After
VAERS Form:2
Age:56.0
Sex:Male
Location:Colorado
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 201A21A / 1 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Ageusia, Anosmia, Asthma, Blood albumin decreased, Blood creatine phosphokinase increased, Blood creatinine increased, Blood glucose increased, Blood sodium decreased, Chest discomfort, Chest pain, Chest X-ray normal, Chills, Condition aggravated, Diabetes mellitus, Diarrhoea, Differential white blood cell count normal, Dyspnoea, Electrocardiogram normal, Fibrin D dimer normal, Full blood count normal, Glycosylated haemoglobin increased, Headache, Hypoglycaemia, Hypoxia, Lung infiltration, Myalgia, Nausea, Protein total decreased, Pyrexia, Tachycardia, Tachypnoea, Vomiting, Troponin increased, Troponin T increased, Echocardiogram abnormal, Metabolic function test, Coagulation test normal, Influenza A virus test negative, Influenza B virus test, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
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)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Cozaar, Norvasc, HCTZ, Lipitor, NovoLIN R, Lantis
Current Illness:
Preexisting Conditions: ASTHMA, CHRONIC KIDNEY DISEASE, DIABETES, HYPERTENSION, TOBACCO ABUSE DX OF COVID-19 15 APRIL 21.
Allergies: NKDA NKDA
Diagnostic Lab Data: 4/15/21 IN ED Port CXR - NEGATIVE, on discussion with Radiologist, subtle focal infiltrate consistent with COVID infiltrates, per ED note. CBC unremarkable; CMP elevated glucose, Elevated Troponin, Creatine Kinase Elevated, D-Dimer within normal range, EKG unremarkable, Influenza A & B negative, COVID 19 Positive, Coag panel within normal limits 4/16/21 CXR - Normal, Glucose - at 1720 374, at 2,225 338 , Troponin T - Elevated21.43 (Ref Range 19), Hemaglobin A1C 13.3 CMP Creatinine 1.36, Sodium low at 131, Glucose 258, D-Dimer within normal limits, CBC unremarkable, 4/17/21 Glucose 47 @ 1720, CMP W/GFR Glucose 43 @ 0500, CBC/W/Diff unremarkable. 4/18/21 Glucose @0215 55 CBC W/Diff unremarkable, CMP@ 0827 Albumin low, Creatinine high, glucose 131, protein low, sodium low, 4/19/21 Echocardiogram: There is an echodensity in the right atrium which measures 1 cm x 1 cm best appreciated in apical four-chamber imaging. This may represent a prominent crista terminalis ridge but recommended further imaging such as cardiac MRI (given acute COVID 19 infection) forfurther evalaution. CBC w/ Diff unremarkable, CMP creatinine high, glucose high, proien low, sodium low.
CDC 'Split Type':

Write-up: Patient received Jassen vaccine 4/10/21. 4/11/21 began with symptoms of fever, headache, chills, nausea, vomiting, and diarrhea, loss of taste and smell. 4/15/21 he presented to ED with symptoms of fever, chest pain and pressure, shortness o breath, myalgias, headache, tachypnea, tachycardia, hypoxia. Was given IV Decadron, DuoNeb and albuerol in ED. Inprovment seen, but patient continued with tachypnea and difficulty breathing. He was admitted to ED with a diagnosis of COVID 19 , asthma exacerbation and elevated Troponin at 31.52 (Ref Range 19) . During admission, glucose levels were labile, requiring adjustment to routine insulin regimen and Glucovance for hypoglycemia. An Echocardiogram was ordered due to elevated Troponin levels on admission. Echocardiogram 4/19/21 showed a density in the right atrium. Cardiology recommended a cardiac MRI. Patient was transfered to Hospital 4/19/21 for elevated care and evaluation, with diagnosis of

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