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This is VAERS ID 1758835

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/8/2021

VAERS ID: 1758835
VAERS Form:2
Age:58.0
Sex:Male
Location:Ohio
Vaccinated:2021-07-14
Onset:2021-10-03
Submitted:0000-00-00
Entered:2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Chest X-ray normal, Cough, Dyspnoea, Vaccine breakthrough infection, COVID-19, SARS-CoV-2 test positive

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:     Extended hospital stay? No
Previous Vaccinations:
Other Medications: albuterol, ASA, duloxetine, empagliflozin, gabapentin, insulin degludec, insulin lispro, metformin, omeprazole, oxybutynin, roflumilast, sotalol, tamsulosin, tiotropium, zolpidem
Current Illness: no
Preexisting Conditions: anxiety, atrial fibrillation, back pain, bladder outlet obstruction, BPH, carotid stenosis, CAD, COPD, DM-2, depression, GERD, HTN, hyperlipidemia, neurogenic bladder, OSA, stroke and tobacco abuse
Allergies: oxycodone, PCN
Diagnostic Lab Data: PCR + 10/3/2021, CXR: unremarkable
CDC 'Split Type':

Write-up: breakthrough Covid + w/ cough/dyspnea

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