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This is VAERS ID 1285561

History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1285561
VAERS Form:2
Age:79.0
Sex:Male
Location:Michigan
Vaccinated:2021-03-12
Onset:2021-04-04
Submitted:0000-00-00
Entered:2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 AR / IM

Administered by: Public      Purchased by: ??
Symptoms: Acute myocardial infarction, Arthralgia, Blood magnesium normal, Cardio-respiratory arrest, Cardioversion, Catheterisation cardiac, Chest pain, Chest X-ray normal, Condition aggravated, Coronary artery disease, Coronary artery occlusion, Death, Electrocardiogram ST segment depression, Full blood count, Haematocrit decreased, Haemoglobin decreased, Hypotension, Hypoxia, Intensive care, Mean cell volume increased, Pain, Pain in jaw, Pulse absent, Rales, Red blood cell count decreased, Resuscitation, Ventricular tachycardia, Vascular graft occlusion, Left ventricular dysfunction, Ejection fraction decreased, Anticoagulant therapy, QRS axis abnormal, Troponin increased, Metabolic function test normal, Bilevel positive airway pressure, Endotracheal intubation, Vascular graft thrombosis, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-06
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NORVASC ASPIRIN LIPITOR PLAVIX HYDREA PRINIVIL TOPROL XL PRILOSEC
Current Illness: unknown
Preexisting Conditions: ACUTE MYOCARDIA INFARCTION ANEMIA CAD S/P CABG (2004) ; PCI CTO THE RCA IN (08/2016) CAROTID ARTERY STENOSIS S/P RIGHT CEA (03/07/2016) DIVERTICULOSIS DYSLIPIDEMIA ESSENTIAL THROMBOCYTOPENIA ETOH ABUSE FALL GERD JAK-2 GENE MUTATION LVH MALLORY-WEISS TEAR MI PROSTATE CANCER
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data: CBC-RBC 3.66, Hb 13.8, HCT 39.2, MCV 107, BMP AND Mag WNL, Troponin #1 11.24, Troponin #2 18.55, CXR-no acute cardiopulmonary process, EKG-NSR, RAD, ST depression in V1, V2, V3, V4, LII, given on Heparin, Morphine, Nitroglycerin, ASA, PLAVIX, LIPITOR AND LOPRESSOR, UNDERWENT LEFT HEART CATH BUT NO INTERVENTION, + for COVID-19
CDC 'Split Type': 47238475152

Write-up: The patient presented with chest pain around 5 pm on 4/4/21. Patient reported "pain came out of nowhere." Patient reported pain was non-exertional and non-positional. He described it as "a constant burning sensation" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD. Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on a small dose nitroglycerine drip. POX 70s, low 80s so Bipap ordered. Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine. Arrested in ICU. Lines were placed by ICU team, arrested again in ICU. Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2. Moderately severe LV dysfunction with and EF 30% 3 The recent NSTEMI is secondary to the occlusion of the SVG-OM1. There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4 The native OM1 is chronically occluded. It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5. Perclose


Changed on 5/14/2021

VAERS ID: 1285561 Before After
VAERS Form:2
Age:79.0
Sex:Male
Location:Michigan
Vaccinated:2021-03-12
Onset:2021-04-04
Submitted:0000-00-00
Entered:2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 AR / IM

Administered by: Public      Purchased by: ??
Symptoms: Acute myocardial infarction, Arthralgia, Blood magnesium normal, Cardio-respiratory arrest, Cardioversion, Catheterisation cardiac, Chest pain, Chest X-ray normal, Condition aggravated, Coronary artery disease, Coronary artery occlusion, Death, Electrocardiogram ST segment depression, Full blood count, Haematocrit decreased, Haemoglobin decreased, Hypotension, Hypoxia, Intensive care, Mean cell volume increased, Pain, Pain in jaw, Pulse absent, Rales, Red blood cell count decreased, Resuscitation, Ventricular tachycardia, Vascular graft occlusion, Left ventricular dysfunction, Ejection fraction decreased, Anticoagulant therapy, QRS axis abnormal, Troponin increased, Metabolic function test normal, Bilevel positive airway pressure, Endotracheal intubation, Vascular graft thrombosis, COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-06
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: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: NORVASC ASPIRIN LIPITOR PLAVIX HYDREA PRINIVIL TOPROL XL PRILOSEC
Current Illness: unknown
Preexisting Conditions: ACUTE MYOCARDIA INFARCTION ANEMIA CAD S/P CABG (2004) ; PCI CTO THE RCA IN (08/2016) CAROTID ARTERY STENOSIS S/P RIGHT CEA (03/07/2016) DIVERTICULOSIS DYSLIPIDEMIA ESSENTIAL THROMBOCYTOPENIA ETOH ABUSE FALL GERD JAK-2 GENE MUTATION LVH MALLORY-WEISS TEAR MI PROSTATE CANCER
Allergies: NO KNOWN ALLERGIES ALLERGIES
Diagnostic Lab Data: CBC-RBC 3.66, Hb 13.8, HCT 39.2, MCV 107, BMP AND Mag WNL, Troponin #1 11.24, Troponin #2 18.55, CXR-no acute cardiopulmonary process, EKG-NSR, RAD, ST depression in V1, V2, V3, V4, LII, given on Heparin, Morphine, Nitroglycerin, ASA, PLAVIX, LIPITOR AND LOPRESSOR, UNDERWENT LEFT HEART CATH BUT NO INTERVENTION, + for COVID-19
CDC 'Split Type': 47238475152

Write-up: The patient presented with chest pain around 5 pm on 4/4/21. Patient reported "pain came out of nowhere." Patient reported pain was non-exertional and non-positional. He described it as "a constant burning sensation" located in the center of his chest with radiation upwards toward his jaw and shoulders, bilaterally. He was transferred to COVID unit, became hypotensive, hypoxic was seen by house MD. Lung exam crackles bilaterally. IV fluids stopped, patient was given 40 mg Lasix, Morphine 2 mg and started on a small dose nitroglycerine drip. POX 70s, low 80s so Bipap ordered. Patient developed v tach and arrested, resuscitated, defibrillated, received multiple meds, intubated by anesthesia, transferred in ICU on Levophed and Epinephrine. Arrested in ICU. Lines were placed by ICU team, arrested again in ICU. Was maxed out on 4 pressors, despite CPR, pulse could not be obtained, patient was pronounced dead 4/6/21 at 3:31am. 1. Triple vessel CAD 2. Moderately severe LV dysfunction with and EF 30% 3 The recent NSTEMI is secondary to the occlusion of the SVG-OM1. There is a large thrombus in the SVG which makes PCI of this vessel unlikely to be successful. 4 The native OM1 is chronically occluded. It may be possible to attempt to open this with CTO techniques, however, at this time continued medical treatment. 5. Perclose

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