National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 6/11/2021 release of VAERS data:

This is VAERS ID 1244543



Case Details

VAERS ID: 1244543 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-12
Onset:2021-04-21
   Days after vaccination:40
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / N/A - / IM

Administered by: Private       Purchased by: ?
Symptoms: Pulmonary embolism
SMQs:, Embolic and thrombotic events, venous (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Colchicine, Requip, Seroquel, albuterol HFA, Klor-Con, Clonidine, Baclofen, Codeine, Lasix prn
Current Illness: Gout
Preexisting Conditions: HTN, Neuropathy, Atopic Derm, Hyperlipidemia, Major Depressive Disorder, Hypothyroid, GERD
Allergies: Naltrexone Hydrochloride
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received J & J vaccine on 3/12/21. PCP states patient was admitted 4/21/21 with Pulmonary Embolism


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1244543


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