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This is VAERS ID 1376902

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1376902
VAERS Form:2
Age:53.0
Sex:Male
Location:Michigan
Vaccinated:2021-04-28
Onset:2021-04-28
Submitted:0000-00-00
Entered:2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Unknown      Purchased by: ??
Symptoms: Dizziness, Dyspnoea exertional, Pulmonary embolism

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)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: Obesity, Lymphedema, History of DVT, Psoriasis
Allergies: Iodine & Shellfish
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient experienced dyspnea on exertion and lightheadedness shortly after receiving vaccine. He continued with these symptoms until presenting to ER on 6/6/2021 and found to have extensive bilateral pulmonary emboli.

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