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This is VAERS ID 1204072

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1204072
VAERS Form:2
Age:24.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-03-04
Onset:2021-04-05
Submitted:0000-00-00
Entered:2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood albumin increased, Condition aggravated, CSF protein increased, Dry mouth, Gait disturbance, Guillain-Barre syndrome, Headache, Hyperaesthesia, Hypoaesthesia, Laboratory test abnormal, Lumbar puncture abnormal, Malaise, Pruritus, Balance disorder, Injection site discomfort, Temperature intolerance, Antinuclear antibody positive, Limb discomfort, Immunoglobulin therapy, Anaesthesia oral, Magnetic resonance imaging spinal abnormal, Magnetic resonance imaging head abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Creatine, multivitamins
Current Illness: None
Preexisting Conditions: none
Allergies: None
Diagnostic Lab Data: MRI, multiple antibody studies that are positive for antinuclear antibodies n Her 2, positive to dilution 1:40 and 1:160 on 4/6 and 1:40 on 4/9, elevated CDG protein and albumin.
CDC 'Split Type':

Write-up: Patient had an initial response 2 days after the vaccine, with general malaise, dry mouth, headache and itching hands as well as local discomfort at the injection site that seemed to resolve spontaneously. On April 3rd he had non-specific changes in his hands that he attributed to cold weather that led to discomfort when running them under warm water. By monday APril 5th he was having worsening sensitivity in his hands and feet to heat, touch and experienced numbness. he also began to have difficulty walking. He went to the ER April 6th and was discharged April 7th after undergoing MRI of the brain and spinal cord, labs and lumbar puncture, with a presumptive diagnosis of early Guillain-barre Syndrome. His symptoms continued to worse, loss of gait was more pronounced as well as loss of balance and new off sensations in his tongue. He was admitted to the hospital, continued to undergo diagnostic workout. Results from tests on APril 6th came back positive for Anti nuclear antibodies and high protein in his CSF. He was treated with 3 days of infused Immunoglobolin therapy and was discharged on April 11th with a diagnosis of likely GBS. His symptoms continue to worsen slightly, but with less day to day decline


Changed on 5/7/2021

VAERS ID: 1204072 Before After
VAERS Form:2
Age:24.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-03-04
Onset:2021-04-05
Submitted:0000-00-00
Entered:2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood albumin increased, Condition aggravated, CSF protein increased, Dry mouth, Gait disturbance, Guillain-Barre syndrome, Headache, Hyperaesthesia, Hypoaesthesia, Laboratory test abnormal, Lumbar puncture abnormal, Malaise, Pruritus, Balance disorder, Injection site discomfort, Temperature intolerance, Antinuclear antibody positive, Limb discomfort, Immunoglobulin therapy, Anaesthesia oral, Magnetic resonance imaging spinal abnormal, Magnetic resonance imaging head abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Creatine, multivitamins
Current Illness: None
Preexisting Conditions: none
Allergies: None None
Diagnostic Lab Data: MRI, multiple antibody studies that are positive for antinuclear antibodies n Her 2, positive to dilution 1:40 and 1:160 on 4/6 and 1:40 on 4/9, elevated CDG protein and albumin.
CDC 'Split Type':

Write-up: Patient had an initial response 2 days after the vaccine, with general malaise, dry mouth, headache and itching hands as well as local discomfort at the injection site that seemed to resolve spontaneously. On April 3rd he had non-specific changes in his hands that he attributed to cold weather that led to discomfort when running them under warm water. By monday APril 5th he was having worsening sensitivity in his hands and feet to heat, touch and experienced numbness. he also began to have difficulty walking. He went to the ER April 6th and was discharged April 7th after undergoing MRI of the brain and spinal cord, labs and lumbar puncture, with a presumptive diagnosis of early Guillain-barre Syndrome. His symptoms continued to worse, loss of gait was more pronounced as well as loss of balance and new off sensations in his tongue. He was admitted to the hospital, continued to undergo diagnostic workout. Results from tests on APril 6th came back positive for Anti nuclear antibodies and high protein in his CSF. He was treated with 3 days of infused Immunoglobolin therapy and was discharged on April 11th with a diagnosis of likely GBS. His symptoms continue to worsen slightly, but with less day to day decline


Changed on 5/14/2021

VAERS ID: 1204072 Before After
VAERS Form:2
Age:24.0
Sex:Male
Location:Massachusetts
Vaccinated:2021-03-04
Onset:2021-04-05
Submitted:0000-00-00
Entered:2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Blood albumin increased, Condition aggravated, CSF protein increased, Dry mouth, Gait disturbance, Guillain-Barre syndrome, Headache, Hyperaesthesia, Hypoaesthesia, Laboratory test abnormal, Lumbar puncture abnormal, Malaise, Pruritus, Balance disorder, Injection site discomfort, Temperature intolerance, Antinuclear antibody positive, Limb discomfort, Immunoglobulin therapy, Anaesthesia oral, Magnetic resonance imaging spinal abnormal, Magnetic resonance imaging head abnormal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
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: Creatine, multivitamins
Current Illness: None
Preexisting Conditions: none
Allergies: None None
Diagnostic Lab Data: MRI, multiple antibody studies that are positive for antinuclear antibodies n Her 2, positive to dilution 1:40 and 1:160 on 4/6 and 1:40 on 4/9, elevated CDG protein and albumin.
CDC 'Split Type':

Write-up: Patient had an initial response 2 days after the vaccine, with general malaise, dry mouth, headache and itching hands as well as local discomfort at the injection site that seemed to resolve spontaneously. On April 3rd he had non-specific changes in his hands that he attributed to cold weather that led to discomfort when running them under warm water. By monday APril 5th he was having worsening sensitivity in his hands and feet to heat, touch and experienced numbness. he also began to have difficulty walking. He went to the ER April 6th and was discharged April 7th after undergoing MRI of the brain and spinal cord, labs and lumbar puncture, with a presumptive diagnosis of early Guillain-barre Syndrome. His symptoms continued to worse, loss of gait was more pronounced as well as loss of balance and new off sensations in his tongue. He was admitted to the hospital, continued to undergo diagnostic workout. Results from tests on APril 6th came back positive for Anti nuclear antibodies and high protein in his CSF. He was treated with 3 days of infused Immunoglobolin therapy and was discharged on April 11th with a diagnosis of likely GBS. His symptoms continue to worsen slightly, but with less day to day decline

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