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This is VAERS ID 1258374

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1258374
VAERS Form:2
Age:62.0
Sex:Male
Location:California
Vaccinated:2021-04-08
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain upper, Chest X-ray, Chills, Confusional state, Fracture, Pain, Retching, Seizure, Venous thrombosis, Vomiting, X-ray, Computerised tomogram head, Laboratory test, Magnetic resonance imaging abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Flomax 0.4mg, lipitor 40mg, lisinopril 20mg, melatonin 5mg, red rice yeast 600mg, CoQ10 30mg
Current Illness: none
Preexisting Conditions: controlled hypertension
Allergies: none
Diagnostic Lab Data: 4/12, labs, chest x-ray, shoulder x-ray, 4/13 CT head, and Adomnal MRI with contrast. 4/ 15 Head MRI with contrast
CDC 'Split Type':

Write-up: 4/9 thru 4/12, body aches, chills. 4/12 0400 throwing up stomach pain from dry heaving throughout the day, confusion starting at 6pm on 4/12. Seizure on 4/12 at 8 pm. 911, ambulance. to Hospital Seizure so severe caused a Fracture in the Right Scapula. MRI on 4/15 showed a venous thrombosis partial occlusion in the brain.


Changed on 5/7/2021

VAERS ID: 1258374 Before After
VAERS Form:2
Age:62.0
Sex:Male
Location:California
Vaccinated:2021-04-08
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain upper, Chest X-ray, Chills, Confusional state, Fracture, Pain, Retching, Seizure, Venous thrombosis, Vomiting, X-ray, Computerised tomogram head, Laboratory test, Magnetic resonance imaging abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Flomax 0.4mg, lipitor 40mg, lisinopril 20mg, melatonin 5mg, red rice yeast 600mg, CoQ10 30mg
Current Illness: none
Preexisting Conditions: controlled hypertension
Allergies: none none
Diagnostic Lab Data: 4/12, labs, chest x-ray, shoulder x-ray, 4/13 CT head, and Adomnal MRI with contrast. 4/ 15 Head MRI with contrast
CDC 'Split Type':

Write-up: 4/9 thru 4/12, body aches, chills. 4/12 0400 throwing up stomach pain from dry heaving throughout the day, confusion starting at 6pm on 4/12. Seizure on 4/12 at 8 pm. 911, ambulance. to Hospital Seizure so severe caused a Fracture in the Right Scapula. MRI on 4/15 showed a venous thrombosis partial occlusion in the brain.


Changed on 5/14/2021

VAERS ID: 1258374 Before After
VAERS Form:2
Age:62.0
Sex:Male
Location:California
Vaccinated:2021-04-08
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain upper, Chest X-ray, Chills, Confusional state, Fracture, Pain, Retching, Seizure, Venous thrombosis, Vomiting, X-ray, Computerised tomogram head, Laboratory test, Magnetic resonance imaging abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Flomax 0.4mg, lipitor 40mg, lisinopril 20mg, melatonin 5mg, red rice yeast 600mg, CoQ10 30mg
Current Illness: none
Preexisting Conditions: controlled hypertension
Allergies: none none
Diagnostic Lab Data: 4/12, labs, chest x-ray, shoulder x-ray, 4/13 CT head, and Adomnal MRI with contrast. 4/ 15 Head MRI with contrast
CDC 'Split Type':

Write-up: 4/9 thru 4/12, body aches, chills. 4/12 0400 throwing up stomach pain from dry heaving throughout the day, confusion starting at 6pm on 4/12. Seizure on 4/12 at 8 pm. 911, ambulance. to Hospital Seizure so severe caused a Fracture in the Right Scapula. MRI on 4/15 showed a venous thrombosis partial occlusion in the brain.

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