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This is VAERS ID 1211008

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1211008
VAERS Form:2
Age:61.0
Sex:Female
Location:Unknown
Vaccinated:2021-04-05
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Abdominal pain upper, Blood thyroid stimulating hormone, Dizziness, Fatigue, Full blood count, Headache, Hyperhidrosis, Loss of consciousness, Muscle spasms, Nightmare, Angiogram, Metabolic function test, Troponin normal

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: N/A
Preexisting Conditions:
Allergies: Erythromycin, Pepto-bismol
Diagnostic Lab Data: ROS: General: No fatigue, fevers/chills, malaise Eyes: No eye pain, eye discharge, visual changes Ears: No ear pain, hearing changes Nose/throat: No nasal congestion, sore throat CV Additional information for Item 19: ROS: General: No fatigue, fevers/chills, malaise Eyes: No eye pain, eye discharge, visual changes Ears: No ear pain, hearing changes Nose/throat: No nasal congestion, sore throat CV: No chest pain, palpitations, syncope, edema Pulm: No SOB, wheezes, cough, hemoptysis GI: No anorexia, abd pain, nausea, vomiting, diarrhea GU: No dysuria, hematuria, urgency, frequency MSK: No joint pain, edema, warmth, redness, deformity Neuro: HA, syncope; No seizures, weakness, numbness/tingling, vertigo, lightheadedness, AMS Skin: No rash, lesions, itching Heme: No easy bruising/bleeding, petechiae All systems reviewed and negative except as stated above. Physical Exam: Vital signs reviewed, no acute intervention necessary General: NAD, AOX3, cooperative Head: Normocephalic, atraumatic Eyes: PERRL, EOMI, no conjunctival injection, no scleral icterus Ears: No edema/erythema of otic canal, no TM edema/erythema/dullness/bulging Nose: No nasal discharge Throat: No pharyngeal edema, erythema, tonsillar exudates, uvular deviation, asymmetric swelling, trismus, drooling, or voice changes Neck: No meningismus; normal ROM Lymph: No cervical lymphadenopathy Respiratory: Unlabored breathing, normal respiratory effort, LCTAB CV: Normal peripheral circulation, RRR, no m/r/g Abd: Soft, NTND Skin: No rashes, petechiae, or purpura Neuro: Grossly intact, moves all extremities equally, gait normal MSK: No TTP, deformity, ecchymosis, or focal edema Psych: Normal mood, normal affect, appropriate responses Labs: CBC/BMP largely unremarkable TSH/FT4 wnl trop NEG Imaging: CT angiography of the head. Indication: Headache. Evaluate for cerebral venous thrombosis. Comparison: None. TECHNIQUE: Axial and reformatted sagittal and coronal images of the brain obtained with IV contrast administration. Findings : No aneurysm is identified in the circle of Willis and its branches. Normal enhancement of the dural venous sinuses without evidence of intraluminal thrombus. Changes from prior left occipital craniotomy. No abnormal post contrast enhancement is noted. Normal size of the ventricles and extra-axial spaces for the patient''s age. Normal white matter tracts of the supratentorial brain. Normal basal ganglia and thalami. Normal brainstem. Normal cerebellum. There is no demonstrated extra-axial, intraparenchymal, or intraventricular hemorrhage. There are no findings of an acute ischemic infarction. There is no demonstrated fracture. Normal visualized paranasal sinuses. IMPRESSION: No aneurysm is identified in the circle of Willis and its branches. Normal enhancement of the dural venous sinuses without evidence of intraluminal thrombus. Changes from prior left occipital craniotomy. No abnormal post contrast enhancement is noted. Electronically signed on Apr 14, 2021 7:18:19 PM JST by: M.D., Certified by ABR, MSK, Neuroradiology EKG: - regular rate (67 bpm) and rhythm - PRI wnl - axis wnl - no sig p-wave abnormalities - no e/o RVH/LVH - QRS wnl - no sig STE/STD - QTc wnl for Pt (430 msec) - T-waves not hyperacute, peaked, or flattened - no U waves - no findings of prolonged QT, delta wave, epsilon wave, Brugada wave, AV block or widened QRS
CDC 'Split Type':

Write-up: vaccine reaction-passed out. c/o worsening headache and feels tire. states broke out sweat, stomach pain, HA, leg cramping and passed out (for about 30sec according to husband) on Mon. took Advil several days. last Advil 0600. J&J vaccine on 5 Apr. 61 yo f w/spouse c/o ongoing headache w/concerns for single episode of ''passing out'' approx 48hrs pta approx 30-45 sec per spouse at bedside; Pt states nighttime episode w/preceding leg crampings, sweating, dizziness, sat on footstool and per spouse passed out but caught by spouse and avoided injury; spontaneous recovery w/o further issue from that episode, spouse denies any post-syncope seizure-like activity/urinary incontinence/tongue biting; Pt and spouse concerned. for cerebral venous thrombosis; Pt has sig hx of prior neurosurgery for posterior/occipital schwannoma around 2017, successfully removed, w/o further findings or complications on f/u (last DEC 2020) to include repeat imaging at that time Pt states has been taking advil OTC for ha but no sig relief at this time; Pt defers need for medications at time of provider evaluation; Pt denies any fevers/ns/chills, cp, sob, palpitations, dyspnea, abd pain/cramping, current nvd, prior syncope, fam hx of MI/SCD/dysrhythmias.


Changed on 5/7/2021

VAERS ID: 1211008 Before After
VAERS Form:2
Age:61.0
Sex:Female
Location:Unknown
Vaccinated:2021-04-05
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Abdominal pain upper, Blood thyroid stimulating hormone, Dizziness, Fatigue, Full blood count, Headache, Hyperhidrosis, Loss of consciousness, Muscle spasms, Nightmare, Angiogram, Metabolic function test, Troponin normal

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: N/A
Preexisting Conditions:
Allergies: Erythromycin, Pepto-bismol Pepto-bismol
Diagnostic Lab Data: ROS: General: No fatigue, fevers/chills, malaise Eyes: No eye pain, eye discharge, visual changes Ears: No ear pain, hearing changes Nose/throat: No nasal congestion, sore throat CV Additional information for Item 19: ROS: General: No fatigue, fevers/chills, malaise Eyes: No eye pain, eye discharge, visual changes Ears: No ear pain, hearing changes Nose/throat: No nasal congestion, sore throat CV: No chest pain, palpitations, syncope, edema Pulm: No SOB, wheezes, cough, hemoptysis GI: No anorexia, abd pain, nausea, vomiting, diarrhea GU: No dysuria, hematuria, urgency, frequency MSK: No joint pain, edema, warmth, redness, deformity Neuro: HA, syncope; No seizures, weakness, numbness/tingling, vertigo, lightheadedness, AMS Skin: No rash, lesions, itching Heme: No easy bruising/bleeding, petechiae All systems reviewed and negative except as stated above. Physical Exam: Vital signs reviewed, no acute intervention necessary General: NAD, AOX3, cooperative Head: Normocephalic, atraumatic Eyes: PERRL, EOMI, no conjunctival injection, no scleral icterus Ears: No edema/erythema of otic canal, no TM edema/erythema/dullness/bulging Nose: No nasal discharge Throat: No pharyngeal edema, erythema, tonsillar exudates, uvular deviation, asymmetric swelling, trismus, drooling, or voice changes Neck: No meningismus; normal ROM Lymph: No cervical lymphadenopathy Respiratory: Unlabored breathing, normal respiratory effort, LCTAB CV: Normal peripheral circulation, RRR, no m/r/g Abd: Soft, NTND Skin: No rashes, petechiae, or purpura Neuro: Grossly intact, moves all extremities equally, gait normal MSK: No TTP, deformity, ecchymosis, or focal edema Psych: Normal mood, normal affect, appropriate responses Labs: CBC/BMP largely unremarkable TSH/FT4 wnl trop NEG Imaging: CT angiography of the head. Indication: Headache. Evaluate for cerebral venous thrombosis. Comparison: None. TECHNIQUE: Axial and reformatted sagittal and coronal images of the brain obtained with IV contrast administration. Findings : No aneurysm is identified in the circle of Willis and its branches. Normal enhancement of the dural venous sinuses without evidence of intraluminal thrombus. Changes from prior left occipital craniotomy. No abnormal post contrast enhancement is noted. Normal size of the ventricles and extra-axial spaces for the patient''s age. Normal white matter tracts of the supratentorial brain. Normal basal ganglia and thalami. Normal brainstem. Normal cerebellum. There is no demonstrated extra-axial, intraparenchymal, or intraventricular hemorrhage. There are no findings of an acute ischemic infarction. There is no demonstrated fracture. Normal visualized paranasal sinuses. IMPRESSION: No aneurysm is identified in the circle of Willis and its branches. Normal enhancement of the dural venous sinuses without evidence of intraluminal thrombus. Changes from prior left occipital craniotomy. No abnormal post contrast enhancement is noted. Electronically signed on Apr 14, 2021 7:18:19 PM JST by: M.D., Certified by ABR, MSK, Neuroradiology EKG: - regular rate (67 bpm) and rhythm - PRI wnl - axis wnl - no sig p-wave abnormalities - no e/o RVH/LVH - QRS wnl - no sig STE/STD - QTc wnl for Pt (430 msec) - T-waves not hyperacute, peaked, or flattened - no U waves - no findings of prolonged QT, delta wave, epsilon wave, Brugada wave, AV block or widened QRS
CDC 'Split Type':

Write-up: vaccine reaction-passed out. c/o worsening headache and feels tire. states broke out sweat, stomach pain, HA, leg cramping and passed out (for about 30sec according to husband) on Mon. took Advil several days. last Advil 0600. J&J vaccine on 5 Apr. 61 yo f w/spouse c/o ongoing headache w/concerns for single episode of ''passing out'' approx 48hrs pta approx 30-45 sec per spouse at bedside; Pt states nighttime episode w/preceding leg crampings, sweating, dizziness, sat on footstool and per spouse passed out but caught by spouse and avoided injury; spontaneous recovery w/o further issue from that episode, spouse denies any post-syncope seizure-like activity/urinary incontinence/tongue biting; Pt and spouse concerned. for cerebral venous thrombosis; Pt has sig hx of prior neurosurgery for posterior/occipital schwannoma around 2017, successfully removed, w/o further findings or complications on f/u (last DEC 2020) to include repeat imaging at that time Pt states has been taking advil OTC for ha but no sig relief at this time; Pt defers need for medications at time of provider evaluation; Pt denies any fevers/ns/chills, cp, sob, palpitations, dyspnea, abd pain/cramping, current nvd, prior syncope, fam hx of MI/SCD/dysrhythmias.


Changed on 5/14/2021

VAERS ID: 1211008 Before After
VAERS Form:2
Age:61.0
Sex:Female
Location:Unknown
Vaccinated:2021-04-05
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Military      Purchased by: ??
Symptoms: Abdominal pain upper, Blood thyroid stimulating hormone, Dizziness, Fatigue, Full blood count, Headache, Hyperhidrosis, Loss of consciousness, Muscle spasms, Nightmare, Angiogram, Metabolic function test, Troponin normal

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: UNK
Current Illness: N/A
Preexisting Conditions:
Allergies: Erythromycin, Pepto-bismol Pepto-bismol
Diagnostic Lab Data: ROS: General: No fatigue, fevers/chills, malaise Eyes: No eye pain, eye discharge, visual changes Ears: No ear pain, hearing changes Nose/throat: No nasal congestion, sore throat CV Additional information for Item 19: ROS: General: No fatigue, fevers/chills, malaise Eyes: No eye pain, eye discharge, visual changes Ears: No ear pain, hearing changes Nose/throat: No nasal congestion, sore throat CV: No chest pain, palpitations, syncope, edema Pulm: No SOB, wheezes, cough, hemoptysis GI: No anorexia, abd pain, nausea, vomiting, diarrhea GU: No dysuria, hematuria, urgency, frequency MSK: No joint pain, edema, warmth, redness, deformity Neuro: HA, syncope; No seizures, weakness, numbness/tingling, vertigo, lightheadedness, AMS Skin: No rash, lesions, itching Heme: No easy bruising/bleeding, petechiae All systems reviewed and negative except as stated above. Physical Exam: Vital signs reviewed, no acute intervention necessary General: NAD, AOX3, cooperative Head: Normocephalic, atraumatic Eyes: PERRL, EOMI, no conjunctival injection, no scleral icterus Ears: No edema/erythema of otic canal, no TM edema/erythema/dullness/bulging Nose: No nasal discharge Throat: No pharyngeal edema, erythema, tonsillar exudates, uvular deviation, asymmetric swelling, trismus, drooling, or voice changes Neck: No meningismus; normal ROM Lymph: No cervical lymphadenopathy Respiratory: Unlabored breathing, normal respiratory effort, LCTAB CV: Normal peripheral circulation, RRR, no m/r/g Abd: Soft, NTND Skin: No rashes, petechiae, or purpura Neuro: Grossly intact, moves all extremities equally, gait normal MSK: No TTP, deformity, ecchymosis, or focal edema Psych: Normal mood, normal affect, appropriate responses Labs: CBC/BMP largely unremarkable TSH/FT4 wnl trop NEG Imaging: CT angiography of the head. Indication: Headache. Evaluate for cerebral venous thrombosis. Comparison: None. TECHNIQUE: Axial and reformatted sagittal and coronal images of the brain obtained with IV contrast administration. Findings : No aneurysm is identified in the circle of Willis and its branches. Normal enhancement of the dural venous sinuses without evidence of intraluminal thrombus. Changes from prior left occipital craniotomy. No abnormal post contrast enhancement is noted. Normal size of the ventricles and extra-axial spaces for the patient''s age. Normal white matter tracts of the supratentorial brain. Normal basal ganglia and thalami. Normal brainstem. Normal cerebellum. There is no demonstrated extra-axial, intraparenchymal, or intraventricular hemorrhage. There are no findings of an acute ischemic infarction. There is no demonstrated fracture. Normal visualized paranasal sinuses. IMPRESSION: No aneurysm is identified in the circle of Willis and its branches. Normal enhancement of the dural venous sinuses without evidence of intraluminal thrombus. Changes from prior left occipital craniotomy. No abnormal post contrast enhancement is noted. Electronically signed on Apr 14, 2021 7:18:19 PM JST by: M.D., Certified by ABR, MSK, Neuroradiology EKG: - regular rate (67 bpm) and rhythm - PRI wnl - axis wnl - no sig p-wave abnormalities - no e/o RVH/LVH - QRS wnl - no sig STE/STD - QTc wnl for Pt (430 msec) - T-waves not hyperacute, peaked, or flattened - no U waves - no findings of prolonged QT, delta wave, epsilon wave, Brugada wave, AV block or widened QRS
CDC 'Split Type':

Write-up: vaccine reaction-passed out. c/o worsening headache and feels tire. states broke out sweat, stomach pain, HA, leg cramping and passed out (for about 30sec according to husband) on Mon. took Advil several days. last Advil 0600. J&J vaccine on 5 Apr. 61 yo f w/spouse c/o ongoing headache w/concerns for single episode of ''passing out'' approx 48hrs pta approx 30-45 sec per spouse at bedside; Pt states nighttime episode w/preceding leg crampings, sweating, dizziness, sat on footstool and per spouse passed out but caught by spouse and avoided injury; spontaneous recovery w/o further issue from that episode, spouse denies any post-syncope seizure-like activity/urinary incontinence/tongue biting; Pt and spouse concerned. for cerebral venous thrombosis; Pt has sig hx of prior neurosurgery for posterior/occipital schwannoma around 2017, successfully removed, w/o further findings or complications on f/u (last DEC 2020) to include repeat imaging at that time Pt states has been taking advil OTC for ha but no sig relief at this time; Pt defers need for medications at time of provider evaluation; Pt denies any fevers/ns/chills, cp, sob, palpitations, dyspnea, abd pain/cramping, current nvd, prior syncope, fam hx of MI/SCD/dysrhythmias.

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