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This is VAERS ID 1136330

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1136330
VAERS Form:2
Age:40.0
Sex:Female
Location:California
Vaccinated:2021-03-20
Onset:2021-03-25
Submitted:0000-00-00
Entered:2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blister, Chills, Headache, Injection site erythema, Injection site pain, Lethargy, Myalgia, Pyrexia, Rash pruritic, Skin warm, Immediate post-injection reaction

Life Threatening? No
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)? No
Hospitalized? No
Previous Vaccinations: At age 26 I received a tetanus vaccine with pertussis and diphtheria and the first vaccine for hepatitis B. That night I went to
Other Medications: Venlafaxine, Amitriptyline, Iron, Multi-Vitamin, Busiprone
Current Illness: No other illnesses
Preexisting Conditions: Complex/Complicated Migraine Headaches (with aura), MDD, GAD
Allergies: Keflex, Septra-DS, Minocycline, Elidel, MAYBE pertussis vaccine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: ADVERSE REACTION TODAY: hot, itchy rash on forearms made up of tiny blisters -- $g no tx thus far -- $g OTHER SIDE EFFECTS: Immediate onset: muscle pain at site of injection Onset about 11 hours post-vaccination: fever, chills, muscle aches, site of injection red and in worse pain, headache Onset about 24 hours post-vaccination: earache off and on Onset about 48 hours post-vaccination: fever spiked at 101.8 Onset about 96 hours post-vaccination: lethargic, headache


Changed on 5/7/2021

VAERS ID: 1136330 Before After
VAERS Form:2
Age:40.0
Sex:Female
Location:California
Vaccinated:2021-03-20
Onset:2021-03-25
Submitted:0000-00-00
Entered:2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Blister, Chills, Headache, Injection site erythema, Injection site pain, Lethargy, Myalgia, Pyrexia, Rash pruritic, Skin warm, Immediate post-injection reaction

Life Threatening? No
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)? No
Hospitalized? No
Previous Vaccinations: At age 26 I received a tetanus vaccine with pertussis and diphtheria and the first vaccine for hepatitis B. That night I went to
Other Medications: Venlafaxine, Amitriptyline, Iron, Multi-Vitamin, Busiprone
Current Illness: No other illnesses
Preexisting Conditions: Complex/Complicated Migraine Headaches (with aura), MDD, GAD
Allergies: Keflex, Septra-DS, Minocycline, Elidel, MAYBE pertussis vaccine vaccine
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: ADVERSE REACTION TODAY: hot, itchy rash on forearms made up of tiny blisters -- $g no tx thus far -- $g OTHER SIDE EFFECTS: Immediate onset: muscle pain at site of injection Onset about 11 hours post-vaccination: fever, chills, muscle aches, site of injection red and in worse pain, headache Onset about 24 hours post-vaccination: earache off and on Onset about 48 hours post-vaccination: fever spiked at 101.8 Onset about 96 hours post-vaccination: lethargic, headache

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