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This is VAERS ID 1264537

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1264537
VAERS Form:2
Age:84.0
Sex:Male
Location:California
Vaccinated:2021-04-03
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Retinal artery occlusion, Ophthalmological examination

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: aspirin 81mg, atorvastatin 80mg, metoprolol 50mg bid, hydralazine 25mg q8, amlodipine 5mg bid
Current Illness:
Preexisting Conditions: thoracic aneurysm, aortic valve regurgitation, cataract, CKD 3, HTN, hyperlipidemia, osteopenia, psoriasis,
Allergies: ciprofloxacin, iv contrast, lisinopril, penicillins, sulfonylureas, vicodin
Diagnostic Lab Data: dilated eye exam
CDC 'Split Type':

Write-up: left central retinal artery occlusion


Changed on 5/7/2021

VAERS ID: 1264537 Before After
VAERS Form:2
Age:84.0
Sex:Male
Location:California
Vaccinated:2021-04-03
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Retinal artery occlusion, Ophthalmological examination

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: aspirin 81mg, atorvastatin 80mg, metoprolol 50mg bid, hydralazine 25mg q8, amlodipine 5mg bid
Current Illness:
Preexisting Conditions: thoracic aneurysm, aortic valve regurgitation, cataract, CKD 3, HTN, hyperlipidemia, osteopenia, psoriasis,
Allergies: ciprofloxacin, iv contrast, lisinopril, penicillins, sulfonylureas, vicodin vicodin
Diagnostic Lab Data: dilated eye exam
CDC 'Split Type':

Write-up: left central retinal artery occlusion


Changed on 5/14/2021

VAERS ID: 1264537 Before After
VAERS Form:2
Age:84.0
Sex:Male
Location:California
Vaccinated:2021-04-03
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Retinal artery occlusion, Ophthalmological examination

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: aspirin 81mg, atorvastatin 80mg, metoprolol 50mg bid, hydralazine 25mg q8, amlodipine 5mg bid
Current Illness:
Preexisting Conditions: thoracic aneurysm, aortic valve regurgitation, cataract, CKD 3, HTN, hyperlipidemia, osteopenia, psoriasis,
Allergies: ciprofloxacin, iv contrast, lisinopril, penicillins, sulfonylureas, vicodin vicodin
Diagnostic Lab Data: dilated eye exam
CDC 'Split Type':

Write-up: left central retinal artery occlusion

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1264537&WAYBACKHISTORY=ON


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