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This is VAERS ID 1258576

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1258576
VAERS Form:2
Age:70.0
Sex:Male
Location:Arkansas
Vaccinated:2021-04-09
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Atrial fibrillation, Cerebral infarction, Intensive care, Thrombosis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: There are several for the long term conditions listed below. I can submit that information a little later today.
Current Illness: None
Preexisting Conditions: Diabetes High blood pressure High Cholesterol
Allergies: None
Diagnostic Lab Data: We will have to get the from the hospital.
CDC 'Split Type':

Write-up: Heart went into Atrial fibrillation causing blood clotting. He has no prior heart condition. A blood clot traveled to his brain causing a Posterior Cerebral Artery Stroke. He has been in ICU since 04/22/2021.


Changed on 5/7/2021

VAERS ID: 1258576 Before After
VAERS Form:2
Age:70.0
Sex:Male
Location:Arkansas
Vaccinated:2021-04-09
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Atrial fibrillation, Cerebral infarction, Intensive care, Thrombosis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: There are several for the long term conditions listed below. I can submit that information a little later today.
Current Illness: None
Preexisting Conditions: Diabetes High blood pressure High Cholesterol
Allergies: None None
Diagnostic Lab Data: We will have to get the from the hospital.
CDC 'Split Type':

Write-up: Heart went into Atrial fibrillation causing blood clotting. He has no prior heart condition. A blood clot traveled to his brain causing a Posterior Cerebral Artery Stroke. He has been in ICU since 04/22/2021.


Changed on 5/14/2021

VAERS ID: 1258576 Before After
VAERS Form:2
Age:70.0
Sex:Male
Location:Arkansas
Vaccinated:2021-04-09
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Atrial fibrillation, Cerebral infarction, Intensive care, Thrombosis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: There are several for the long term conditions listed below. I can submit that information a little later today.
Current Illness: None
Preexisting Conditions: Diabetes High blood pressure High Cholesterol
Allergies: None None
Diagnostic Lab Data: We will have to get the from the hospital.
CDC 'Split Type':

Write-up: Heart went into Atrial fibrillation causing blood clotting. He has no prior heart condition. A blood clot traveled to his brain causing a Posterior Cerebral Artery Stroke. He has been in ICU since 04/22/2021.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1258576&WAYBACKHISTORY=ON


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