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This is VAERS ID 1105748

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History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1105748
VAERS Form:2
Age:73.0
Sex:Male
Location:Maryland
Vaccinated:2021-03-16
Onset:2021-03-16
Submitted:0000-00-00
Entered:2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Computerised tomogram abnormal, Dysarthria, Heart rate irregular, Vision blurred, Balance disorder, Blood test abnormal, Ischaemic stroke, Magnetic resonance imaging abnormal

Life Threatening? Yes
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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine (NORVASC) asprin (ECOTRIN) metoprolol (LOPRESSOR)
Current Illness: none
Preexisting Conditions: hypertension
Allergies: shellfish, iodine
Diagnostic Lab Data: CT Scan - March 11 MRI - March 11 Blood Tests - March 11-13
CDC 'Split Type':

Write-up: Thursday, March 11, 2021 (approximately 8:30 am) Patient experienced blurred vision, unbalance, and slurred speech and had an irregular heartbeat. March 11, 2021 (approximately 11:30 am) Patient was admitted to Hospital administered CT scan, MRI and multiple blood tests. Diagnosis - Ischemic Stroke


Changed on 5/7/2021

VAERS ID: 1105748 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Maryland
Vaccinated:2021-03-16
Onset:2021-03-16
Submitted:0000-00-00
Entered:2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Computerised tomogram abnormal, Dysarthria, Heart rate irregular, Vision blurred, Balance disorder, Blood test abnormal, Ischaemic stroke, Magnetic resonance imaging abnormal

Life Threatening? Yes
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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine (NORVASC) asprin (ECOTRIN) metoprolol (LOPRESSOR)
Current Illness: none
Preexisting Conditions: hypertension
Allergies: shellfish, iodine iodine
Diagnostic Lab Data: CT Scan - March 11 MRI - March 11 Blood Tests - March 11-13
CDC 'Split Type':

Write-up: Thursday, March 11, 2021 (approximately 8:30 am) Patient experienced blurred vision, unbalance, and slurred speech and had an irregular heartbeat. March 11, 2021 (approximately 11:30 am) Patient was admitted to Hospital administered CT scan, MRI and multiple blood tests. Diagnosis - Ischemic Stroke


Changed on 5/14/2021

VAERS ID: 1105748 Before After
VAERS Form:2
Age:73.0
Sex:Male
Location:Maryland
Vaccinated:2021-03-16
Onset:2021-03-16
Submitted:0000-00-00
Entered:2021-03-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Computerised tomogram abnormal, Dysarthria, Heart rate irregular, Vision blurred, Balance disorder, Blood test abnormal, Ischaemic stroke, Magnetic resonance imaging abnormal

Life Threatening? Yes
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? Yes, days: 3     Extended hospital stay? No
Previous Vaccinations:
Other Medications: amlodipine (NORVASC) asprin (ECOTRIN) metoprolol (LOPRESSOR)
Current Illness: none
Preexisting Conditions: hypertension
Allergies: shellfish, iodine iodine
Diagnostic Lab Data: CT Scan - March 11 MRI - March 11 Blood Tests - March 11-13
CDC 'Split Type':

Write-up: Thursday, March 11, 2021 (approximately 8:30 am) Patient experienced blurred vision, unbalance, and slurred speech and had an irregular heartbeat. March 11, 2021 (approximately 11:30 am) Patient was admitted to Hospital administered CT scan, MRI and multiple blood tests. Diagnosis - Ischemic Stroke

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