National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1257187

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1257187
VAERS Form:2
Age:80.0
Sex:Female
Location:Texas
Vaccinated:2021-03-09
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Pulmonary embolism

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None reported by patient
Current Illness: Patient reported none but does not fill prescription with the same pharmacy when vaccine was given
Preexisting Conditions: None reported by patient
Allergies: None reported by patient
Diagnostic Lab Data: None was given to the pharmacy
CDC 'Split Type':

Write-up: Patient family called on 4/23/2021 and reported that patient was hospitalized on April 9th and 13th , 2021 for blood clot in the lungs after taking the Johnson & Johnson covid-19 vaccine on 3/09/2021. During the time of the report patient''s family state that patient was stable and she is doing okay.


Changed on 5/7/2021

VAERS ID: 1257187 Before After
VAERS Form:2
Age:80.0
Sex:Female
Location:Texas
Vaccinated:2021-03-09
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Pulmonary embolism

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None reported by patient
Current Illness: Patient reported none but does not fill prescription with the same pharmacy when vaccine was given
Preexisting Conditions: None reported by patient
Allergies: None reported by patient patient
Diagnostic Lab Data: None was given to the pharmacy
CDC 'Split Type':

Write-up: Patient family called on 4/23/2021 and reported that patient was hospitalized on April 9th and 13th , 2021 for blood clot in the lungs after taking the Johnson & Johnson covid-19 vaccine on 3/09/2021. During the time of the report patient''s family state that patient was stable and she is doing okay.


Changed on 5/14/2021

VAERS ID: 1257187 Before After
VAERS Form:2
Age:80.0
Sex:Female
Location:Texas
Vaccinated:2021-03-09
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Pulmonary embolism

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None reported by patient
Current Illness: Patient reported none but does not fill prescription with the same pharmacy when vaccine was given
Preexisting Conditions: None reported by patient
Allergies: None reported by patient patient
Diagnostic Lab Data: None was given to the pharmacy
CDC 'Split Type':

Write-up: Patient family called on 4/23/2021 and reported that patient was hospitalized on April 9th and 13th , 2021 for blood clot in the lungs after taking the Johnson & Johnson covid-19 vaccine on 3/09/2021. During the time of the report patient''s family state that patient was stable and she is doing okay.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1257187&WAYBACKHISTORY=ON


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