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This is VAERS ID 1383640

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1383640
VAERS Form:2
Age:72.0
Sex:Male
Location:Illinois
Vaccinated:2021-05-02
Onset:2021-06-06
Submitted:0000-00-00
Entered:2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Abdominal pain, Chest X-ray, Computerised tomogram, Fall, Fatigue, Hypotension, Thrombosis, Ultrasound Doppler abnormal, Urinary incontinence, Urinary tract infection, White blood cell count increased, Blood test, Respiratory symptom, Anal incontinence

Life Threatening? Yes
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:
Current Illness: None
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: CT scan, ultrasound, chest xray, blood work, while in hospital
CDC 'Split Type':

Write-up: Shortly after vaccine, upper respiratory issue started. Fatigue, falling, soiling bed sheets and pants regularly. Then went to hospital on june 7th with abdominal pain. Low bloid pressure and hight white blood count. Had blood clot. Urinary Infection Possible sepsis. Still in hospital.

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