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This is VAERS ID 1242683

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1242683
VAERS Form:2
Age:53.0
Sex:Male
Location:Unknown
Vaccinated:2021-04-09
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Cerebrovascular accident, Ultrasound Doppler abnormal, Deep vein thrombosis, Basal ganglia haemorrhage

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nifedipine
Current Illness:
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Deep Vein Thrombosis- occlusive and non-occlusive in R axial and R brachial veins at level of PICC line. Pt admitted to hospital on 4/18/21 with acute basal ganglia hemorrhagic CVA, with PICC line placement on admission. DVTs identified on 4/21 via ultrasound. Pt currently admitted to Hospital


Changed on 5/7/2021

VAERS ID: 1242683 Before After
VAERS Form:2
Age:53.0
Sex:Male
Location:Unknown
Vaccinated:2021-04-09
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Cerebrovascular accident, Ultrasound Doppler abnormal, Deep vein thrombosis, Basal ganglia haemorrhage

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nifedipine
Current Illness:
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Deep Vein Thrombosis- occlusive and non-occlusive in R axial and R brachial veins at level of PICC line. Pt admitted to hospital on 4/18/21 with acute basal ganglia hemorrhagic CVA, with PICC line placement on admission. DVTs identified on 4/21 via ultrasound. Pt currently admitted to Hospital


Changed on 5/14/2021

VAERS ID: 1242683 Before After
VAERS Form:2
Age:53.0
Sex:Male
Location:Unknown
Vaccinated:2021-04-09
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Cerebrovascular accident, Ultrasound Doppler abnormal, Deep vein thrombosis, Basal ganglia haemorrhage

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Nifedipine
Current Illness:
Preexisting Conditions: Hypertension
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Deep Vein Thrombosis- occlusive and non-occlusive in R axial and R brachial veins at level of PICC line. Pt admitted to hospital on 4/18/21 with acute basal ganglia hemorrhagic CVA, with PICC line placement on admission. DVTs identified on 4/21 via ultrasound. Pt currently admitted to Hospital

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1242683&WAYBACKHISTORY=ON


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