National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1262924

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1262924
VAERS Form:2
Age:76.0
Sex:Male
Location:Florida
Vaccinated:2021-03-30
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Platelet count decreased, Pulmonary embolism, Syncope, Heparin-induced thrombocytopenia test, Deep vein thrombosis, Anticoagulant therapy, Infusion, Myocardial strain

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Primidone 250 mg po two times daily Atorvastatin 20 mg po every day Lisinopril 20 mg po daily Metoprolol 25 mg po twice daily Calcium carbonate-vitamin D3 - 400 unit tablet 1 tablet daily furosemide 40 mg po daily aspirin 81 mg po daily bac
Current Illness:
Preexisting Conditions: HTN CAD
Allergies: NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received J&J vaccine 3/30/21 4/21/21 Presented to hospital with syncope and collapse, work-up for NSTEMI and placed on heparin infusion Patient found to have RLE DVT and bilateral PE with right heart strain. Platelet decreased and patient started on argatroban infusion. HIT negative, platelets remaind stable. Discharged 4/25/21 on apixaban


Changed on 5/7/2021

VAERS ID: 1262924 Before After
VAERS Form:2
Age:76.0
Sex:Male
Location:Florida
Vaccinated:2021-03-30
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Platelet count decreased, Pulmonary embolism, Syncope, Heparin-induced thrombocytopenia test, Deep vein thrombosis, Anticoagulant therapy, Infusion, Myocardial strain

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Primidone 250 mg po two times daily Atorvastatin 20 mg po every day Lisinopril 20 mg po daily Metoprolol 25 mg po twice daily Calcium carbonate-vitamin D3 - 400 unit tablet 1 tablet daily furosemide 40 mg po daily aspirin 81 mg po daily bac
Current Illness:
Preexisting Conditions: HTN CAD
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received J&J vaccine 3/30/21 4/21/21 Presented to hospital with syncope and collapse, work-up for NSTEMI and placed on heparin infusion Patient found to have RLE DVT and bilateral PE with right heart strain. Platelet decreased and patient started on argatroban infusion. HIT negative, platelets remaind stable. Discharged 4/25/21 on apixaban


Changed on 5/14/2021

VAERS ID: 1262924 Before After
VAERS Form:2
Age:76.0
Sex:Male
Location:Florida
Vaccinated:2021-03-30
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Platelet count decreased, Pulmonary embolism, Syncope, Heparin-induced thrombocytopenia test, Deep vein thrombosis, Anticoagulant therapy, Infusion, Myocardial strain

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Primidone 250 mg po two times daily Atorvastatin 20 mg po every day Lisinopril 20 mg po daily Metoprolol 25 mg po twice daily Calcium carbonate-vitamin D3 - 400 unit tablet 1 tablet daily furosemide 40 mg po daily aspirin 81 mg po daily bac
Current Illness:
Preexisting Conditions: HTN CAD
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received J&J vaccine 3/30/21 4/21/21 Presented to hospital with syncope and collapse, work-up for NSTEMI and placed on heparin infusion Patient found to have RLE DVT and bilateral PE with right heart strain. Platelet decreased and patient started on argatroban infusion. HIT negative, platelets remaind stable. Discharged 4/25/21 on apixaban

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1262924&WAYBACKHISTORY=ON


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