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This is VAERS ID 1208205

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1208205
VAERS Form:2
Age:70.0
Sex:Female
Location:Georgia
Vaccinated:2021-03-27
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Abdominal pain lower, Erythema, Pain in extremity, Skin warm, Swelling, Thrombophlebitis, Deep vein thrombosis

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Advil, losartan potassium
Current Illness:
Preexisting Conditions: High blood pressure. herpes simplex
Allergies: hazelnut, penicillins, amoxicillin, sulfamethoxazole, Vitamin - B
Diagnostic Lab Data: urgent care medical examination (April 14, 2021) waiting primary cared physician exam on April 15, 2021
CDC 'Split Type':

Write-up: deep vein thrombosis, swelling, pain in both legs and lower abdomen. warm and red skin. red swollen veins.


Changed on 5/7/2021

VAERS ID: 1208205 Before After
VAERS Form:2
Age:70.0
Sex:Female
Location:Georgia
Vaccinated:2021-03-27
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Abdominal pain lower, Erythema, Pain in extremity, Skin warm, Swelling, Thrombophlebitis, Deep vein thrombosis

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Advil, losartan potassium
Current Illness:
Preexisting Conditions: High blood pressure. herpes simplex
Allergies: hazelnut, penicillins, amoxicillin, sulfamethoxazole, Vitamin - B B
Diagnostic Lab Data: urgent care medical examination (April 14, 2021) waiting primary cared physician exam on April 15, 2021
CDC 'Split Type':

Write-up: deep vein thrombosis, swelling, pain in both legs and lower abdomen. warm and red skin. red swollen veins.


Changed on 5/14/2021

VAERS ID: 1208205 Before After
VAERS Form:2
Age:70.0
Sex:Female
Location:Georgia
Vaccinated:2021-03-27
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Abdominal pain lower, Erythema, Pain in extremity, Skin warm, Swelling, Thrombophlebitis, Deep vein thrombosis

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Advil, losartan potassium
Current Illness:
Preexisting Conditions: High blood pressure. herpes simplex
Allergies: hazelnut, penicillins, amoxicillin, sulfamethoxazole, Vitamin - B B
Diagnostic Lab Data: urgent care medical examination (April 14, 2021) waiting primary cared physician exam on April 15, 2021
CDC 'Split Type':

Write-up: deep vein thrombosis, swelling, pain in both legs and lower abdomen. warm and red skin. red swollen veins.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1208205&WAYBACKHISTORY=ON

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