National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 10/8/2021 release of VAERS data:

This is VAERS ID 1207898



Case Details

VAERS ID: 1207898 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-07
Onset:2021-04-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / N/A LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Alanine aminotransferase normal, Albumin globulin ratio decreased, Angiogram cerebral abnormal, Anion gap decreased, Arteriogram carotid abnormal, Aspartate aminotransferase normal, Back pain, Basophil count normal, Basophil percentage, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bilirubin normal, Blood calcium decreased, Blood chloride increased, Blood creatinine normal, Blood glucose normal, Blood osmolarity decreased, Blood potassium normal, Blood sodium normal, Blood urea decreased, Blood urea nitrogen/creatinine ratio, Carbon dioxide normal, Central nervous system lesion, Chest pain, Differential white blood cell count, Dizziness postural, Eosinophil count normal, Eosinophil percentage, Facial asymmetry, Facial paralysis, Feeling abnormal, Globulins increased, Glomerular filtration rate normal, Granulocyte percentage, Haematocrit normal, Haemoglobin normal, Head discomfort, Hypopnoea, Immature granulocyte count, International normalised ratio normal, Lymphocyte count normal, Lymphocyte percentage, Mean cell haemoglobin concentration normal, Mean cell haemoglobin normal, Mean cell volume normal, Mean platelet volume increased, Meningioma, Monocyte count normal, Monocyte percentage, Musculoskeletal chest pain, Musculoskeletal discomfort, Neutrophil count normal, Neutrophil percentage, Nucleated red cells, Ocular discomfort, Pain in extremity, Painful respiration, Paraesthesia, Platelet count normal, Protein total normal, Prothrombin time prolonged, Red blood cell count normal, Red cell distribution width normal, Sensory loss, Sinus disorder, Soft tissue inflammation, Thrombophlebitis superficial, Varicose vein, Visual impairment, White blood cell count normal
SMQs:, Rhabdomyolysis/myopathy (broad), Liver-related coagulation and bleeding disturbances (narrow), Peripheral neuropathy (narrow), Haemorrhage laboratory terms (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hyponatraemia/SIADH (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hearing impairment (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Tubulointerstitial diseases (broad), Respiratory failure (narrow), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: vitamin D 4000 IU daily over the counter, Zyrtec 10 mg daily as needed over the counter, Cryselle 28 norgestrel-ethinyl estradiol 0.3-30 mg-mcg per tablet once daily, lisinopril 40 mg daily.
Current Illness: None known.
Preexisting Conditions: Essential hypertension, chronic neck and back pain, chronic venous insufficiency, BMI 30.50, vitamin D deficiency, pure hypercholesterolemia,
Allergies: Lidocaine oral spray - anaphylaxis. Orange fruit/orange flavoring - hives swelling, rash. Prednisone - anaphylaxis. Hydrocodone-acetaminophen - rash. Metoprolol - rash. Sulfa antibiotics - rash. Mucinex Swelling lower extremities and throat.
Diagnostic Lab Data: CT ANGIOGRAM HEAD AND NECK IMPRESSION: 1.Negative for dural venous sinus thrombosis. Bilateral filling defects seen in the transverse sinuses are most likely arachnoid granulations. 2.Negative for DVT in the internal jugular or subclavian veins in the neck. 3.Filling defect seen within a tortuous superficial vein adjacent to the right sternoclavicular joint, consistent with a superficial venous thrombosis. The exact origin of the vein is uncertain but it appears to drain into the right subclavian vein via some engorged collaterals. Surrounding mild soft tissue inflammation and venous varices are noted. This corresponds to the site of patient''s symptoms and palpable abnormality. The right subclavian vein itself is free of clot at this time. 4.Approximately 2.2 cm diameter likely extra-axial hyperdense lesion in the anterior cranial fossa extending to the right of midline, without any adjacent vessels in the area to suspect aneurysm. This most likely reflects a planum sphenoidale meningioma. Recommend follow-up evaluation with nonemergent contrast enhanced MRI. I discussed these results with Dr. Dunaway via telephone at 4/13/2021 17:46, immediately at the time of interpretation. Report signed on 4/13/2021 5:47 PM Report created with Powerscribe360 Component WBC Value: 7.31 Flag: Ref Range: 3.87 - 9.10 Units: 10*3/uL Status: Final RBC Value: 4.69 Flag: Ref Range: 3.92 - 4.97 Units: 10*6/uL Status: Final HGB Value: 13.9 Flag: Ref Range: 12.1 - 14.8 Units: g/dL Status: Final HCT Value: 42.5 Flag: Ref Range: 37.1 - 45.1 Units: % Status: Final MCV Value: 90.6 Flag: Ref Range: 82.0 - 99.0 Units: fL Status: Final MCH Value: 29.6 Flag: Ref Range: 28.5 - 32.1 Units: pg Status: Final MCHC Value: 32.7 Flag: Ref Range: 31.4 - 34.5 Units: g/dL Status: Final Platelets Value: 288 Flag: Ref Range: 150 - 400 Units: 10*3/uL Status: Final RDW-CV Value: 13.1 Flag: Ref Range: 11.4 - 14.0 Units: % Status: Final NRBC Absolute Value: 0.00 Flag: Ref Range: 0 Units: 10*3/uL Status: Final MPV Value: 10.5 Flag: Ref Range: 8.8 - 12.2 Units: fL Status: Final Differential Type Flag: Status: Final AUTOMATED DIFFERENTIAL Neutrophil % Value: 60.2 Flag: Units: % Status: Final Neutrophils Absolute Value: 4.40 Flag: Ref Range: 1.57 - 6.01 Units: 10*3/uL Status: Final Lymphocytes % Value: 32.7 Flag: Units: % Status: Final Lymphocytes Absolute Value: 2.39 Flag: Ref Range: 0.92 - 2.93 Units: 10*3/uL Status: Final Monocyte % Value: 5.2 Flag: Units: % Status: Final Monos Absolute Value: 0.38 Flag: Ref Range: 0.26 - 0.87 Units: 10*3/uL Status: Final Eosinophils Relative % Value: 1.1 Flag: Units: % Status: Final Eosinophils Absolute Count Value: 0.08 Flag: Ref Range: 0.0 - 0.35 Units: 10*3/uL Status: Final Basophils % Value: 0.5 Flag: Units: % Status: Final Basophils Absolute Value: 0.04 Flag: Ref Range: 0.01 - 0.09 Units: 10*3/uL Status: Final Immature Granulocytes% Value: 0.3 Flag: Units: % Status: Final Immature Granulocytes Absolute Value: 0.02 Flag: Ref Range: 0.00 - 0.05 Units: 10*3/uL Status: Final Component Value Flag Ref Range Units Status Sodium 138 135 - 145 mmol/L Final Potassium 3.9 3.5 - 5.1 mmol/L Final Chloride 107 98 - 107 mmol/L Final CO2 29 21 - 32 mmol/L Final Glucose 97 65 - 100 mg/dL Final BUN 9 5 - 20 mg/dL Final Creatinine 0.69 0.55 - 1.02 mg/dL Final Calcium 8.5 8.3 - 10.3 mg/dL Final Total Protein 7.1 6.4 - 8.3 g/dL Final Albumin 3.2 Low 3.4 - 5.0 g/dL Final Bilirubin Total 0.4 0.2 - 1.0 mg/dL Final Alkaline Phosphatase 85 45 - 117 U/L Final AST 14 Low 15 - 37 U/L Final ALT 18 13 - 56 U/L Final Anion Gap 2 Low 6 - 14 mmol/L Final BUN/Creatinine Ratio 13.0 Final Osmolality Calculated 274 mosm/kg Final Globulin 3.9 g/dL Final A/G Ratio 0.8 Low 1.2 - 2.4 Final Creatinine Based eGFR $g90 $g60 mL/min/[1.73_m2] Final Status: Final result (Collected: 4/13/2021 13:55) Provider Status: Ordered Component Value Flag Ref Range Units Status PTT 25.4 22.6 - 34.1 s Final Comment: Therapeutic range for Heparin Monitoring based on serum concentrations of 0.3-0.7 units/mL. Therapeutic APTT range: 67-101 seconds Status: Final result (Collected: 4/13/2021 13:55) Provider Status: Ordered Component Value Flag Ref Range Units Status Protime 12.6 11.5 - 14.4 s Final INR 1.0 Final Comment: ---- THERAPEUTIC RANGE: Patients on standard dose for treatment of prophlaxis of thrombosis or embolism: Target INR Range: 2.0-3.0 High risk patients with mechanical heart valves: Target INR Range: 2.5-3.5
CDC Split Type:

Write-up: Left arm and left neck/face tingling, decreased sensation with subsequent Bell''s palsy like facial asymmetry on the left side, brain fog, dizziness with position changes, pressure in head when bending over behind the left eye, aching pain in left arm, fullness in the anterior lower right neck, episode of visual stars, food and drink dripping/falling out of left side of mouth, Pain in left rib cage/chest into the left back causing her to breath shallower. ER evaluation confirmed CT finding of right superficial vein thrombosis just above the sternoclavicular joint - see imaging report info.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1207898

Government Disclaimer on use of this data


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