National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1204923

Government Disclaimer on use of this data

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1204923
VAERS Form:2
Age:66.0
Sex:Female
Location:Oregon
Vaccinated:2021-03-12
Onset:2021-03-25
Submitted:0000-00-00
Entered:2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1085018 / 1 UN / IM

Administered by: Other      Purchased by: ??
Symptoms: Guillain-Barre syndrome

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: apixaban (ELIQUIS) , cetirizine (ZYRTEC), digoxin, Ergocalciferol, Vitamin D2, furosemide, levothyroxine, potassium chloride (KLOR-CON M, VITAMIN B COMPLEX ORAL
Current Illness: heart failure, restrictive pericarditis
Preexisting Conditions: Hodgkins, BCL, afib, heart failure
Allergies: flecainide, amiodarone
Diagnostic Lab Data: Diagnosis of exclusion
CDC 'Split Type':

Write-up: Guillain-Barr? syndrome


Changed on 5/7/2021

VAERS ID: 1204923 Before After
VAERS Form:2
Age:66.0
Sex:Female
Location:Oregon
Vaccinated:2021-03-12
Onset:2021-03-25
Submitted:0000-00-00
Entered:2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1085018 / 1 UN / IM

Administered by: Other      Purchased by: ??
Symptoms: Guillain-Barre syndrome

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: apixaban (ELIQUIS) , cetirizine (ZYRTEC), digoxin, Ergocalciferol, Vitamin D2, furosemide, levothyroxine, potassium chloride (KLOR-CON M, VITAMIN B COMPLEX ORAL
Current Illness: heart failure, restrictive pericarditis
Preexisting Conditions: Hodgkins, BCL, afib, heart failure
Allergies: flecainide, amiodarone amiodarone
Diagnostic Lab Data: Diagnosis of exclusion
CDC 'Split Type':

Write-up: Guillain-Barr? Guillain-Barré syndrome


Changed on 5/14/2021

VAERS ID: 1204923 Before After
VAERS Form:2
Age:66.0
Sex:Female
Location:Oregon
Vaccinated:2021-03-12
Onset:2021-03-25
Submitted:0000-00-00
Entered:2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1085018 / 1 UN / IM

Administered by: Other      Purchased by: ??
Symptoms: Guillain-Barre syndrome

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 19     Extended hospital stay? No
Previous Vaccinations:
Other Medications: apixaban (ELIQUIS) , cetirizine (ZYRTEC), digoxin, Ergocalciferol, Vitamin D2, furosemide, levothyroxine, potassium chloride (KLOR-CON M, VITAMIN B COMPLEX ORAL
Current Illness: heart failure, restrictive pericarditis
Preexisting Conditions: Hodgkins, BCL, afib, heart failure
Allergies: flecainide, amiodarone amiodarone
Diagnostic Lab Data: Diagnosis of exclusion
CDC 'Split Type':

Write-up: Guillain-Barré Guillain-Barr? syndrome

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1204923&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166