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This is VAERS ID 1172503

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1172503
VAERS Form:2
Age:69.0
Sex:Male
Location:New York
Vaccinated:2021-03-11
Onset:2021-03-25
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802072 / 1 RA / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Asthenia, CSF protein increased, Guillain-Barre syndrome, Lumbar puncture abnormal, White blood cell count decreased

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Valsartan-HCTZ, rosuvastain, ASA
Current Illness: None
Preexisting Conditions: HTN, HLD
Allergies: No known allergies
Diagnostic Lab Data: Lumbar puncture with CSF protein 219, WBC 3
CDC 'Split Type':

Write-up: Patient with progressive ascending weakness over 2 weeks. Diagnosed with Guillain-Barre Syndrome.


Changed on 5/7/2021

VAERS ID: 1172503 Before After
VAERS Form:2
Age:69.0
Sex:Male
Location:New York
Vaccinated:2021-03-11
Onset:2021-03-25
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802072 / 1 RA / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Asthenia, CSF protein increased, Guillain-Barre syndrome, Lumbar puncture abnormal, White blood cell count decreased

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Valsartan-HCTZ, rosuvastain, ASA
Current Illness: None
Preexisting Conditions: HTN, HLD
Allergies: No known allergies allergies
Diagnostic Lab Data: Lumbar puncture with CSF protein 219, WBC 3
CDC 'Split Type':

Write-up: Patient with progressive ascending weakness over 2 weeks. Diagnosed with Guillain-Barre Syndrome.


Changed on 5/14/2021

VAERS ID: 1172503 Before After
VAERS Form:2
Age:69.0
Sex:Male
Location:New York
Vaccinated:2021-03-11
Onset:2021-03-25
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802072 / 1 RA / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Asthenia, CSF protein increased, Guillain-Barre syndrome, Lumbar puncture abnormal, White blood cell count decreased

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: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Valsartan-HCTZ, rosuvastain, ASA
Current Illness: None
Preexisting Conditions: HTN, HLD
Allergies: No known allergies allergies
Diagnostic Lab Data: Lumbar puncture with CSF protein 219, WBC 3
CDC 'Split Type':

Write-up: Patient with progressive ascending weakness over 2 weeks. Diagnosed with Guillain-Barre Syndrome.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1172503&WAYBACKHISTORY=ON

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