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This is VAERS ID 1244543

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1244543
VAERS Form:2
Age:59.0
Sex:Male
Location:California
Vaccinated:2021-03-12
Onset:2021-04-21
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

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? Yes, days: 2     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


Changed on 5/7/2021

VAERS ID: 1244543 Before After
VAERS Form:2
Age:59.0
Sex:Male
Location:California
Vaccinated:2021-03-12
Onset:2021-04-21
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

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? Yes, days: 2     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 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


Changed on 5/14/2021

VAERS ID: 1244543 Before After
VAERS Form:2
Age:59.0
Sex:Male
Location:California
Vaccinated:2021-03-12
Onset:2021-04-21
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

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? Yes, days: 2     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 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

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


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