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From the 6/4/2021 release of VAERS data:

This is VAERS ID 1221027



Case Details

VAERS ID: 1221027 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Michigan  
Vaccinated:2021-04-05
Onset:2021-04-11
   Days after vaccination:6
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest pain, Cough, Full blood count, Inflammatory marker test, Migraine, Pain, Vertigo, Visual impairment
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Glaucoma (broad), Optic nerve disorders (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (narrow), 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Armour Thyroid 90 mg; prometrium 200 mg, Valganciclovir 450 mg 2x''s daily, HyQvia 25 grams sub cutaneous every 3 weeks. Missed 2 infusions due to health insurance. Infused 4-01-21
Current Illness: CVID
Preexisting Conditions: CVID, mycoplasma fermentans
Allergies: Ilosone, chlorahexadine
Diagnostic Lab Data: inflammatory markers, CBC, sedimentation
CDC Split Type:

Write-up: Worst migraine ever continuing even into 4-16-21 (today), vertigo, chest pain, cough, severe body aches, vison problems


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1221027


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