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This is VAERS ID 1225311

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1225311
VAERS Form:2
Age:68.0
Sex:Male
Location:North Carolina
Vaccinated:2021-03-15
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Pain in extremity, Physical examination, Peripheral swelling

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: Synthroid, Lexapro, Abilify, Senna-S, Miralax
Current Illness: Hypothyroidism, primary progressive aphasia.
Preexisting Conditions: Hypothyroidism, primary progressive aphasia.
Allergies: No known drug or food allergies.
Diagnostic Lab Data: UNABLE TO EVALUATE OTHER THAN PHYSICAL EXAM AT PATIENT HOME BY SUPPORTING MEDICAL TEAM.
CDC 'Split Type':

Write-up: SUDDEN ONSET OF SWELLING IN ENTIRE LEFT LOWER EXTREMITY ON APRIL 11, 2021. NO RECENT TRAUMA , CHANGE IN AMBULATORY STATUS OR CHANGE IN HYDRATION OR ORAL INTAKE.


Changed on 5/7/2021

VAERS ID: 1225311 Before After
VAERS Form:2
Age:68.0
Sex:Male
Location:North Carolina
Vaccinated:2021-03-15
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Pain in extremity, Physical examination, Peripheral swelling

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: Synthroid, Lexapro, Abilify, Senna-S, Miralax
Current Illness: Hypothyroidism, primary progressive aphasia.
Preexisting Conditions: Hypothyroidism, primary progressive aphasia.
Allergies: No known drug or food allergies. allergies.
Diagnostic Lab Data: UNABLE TO EVALUATE OTHER THAN PHYSICAL EXAM AT PATIENT HOME BY SUPPORTING MEDICAL TEAM.
CDC 'Split Type':

Write-up: SUDDEN ONSET OF SWELLING IN ENTIRE LEFT LOWER EXTREMITY ON APRIL 11, 2021. NO RECENT TRAUMA , CHANGE IN AMBULATORY STATUS OR CHANGE IN HYDRATION OR ORAL INTAKE.


Changed on 5/14/2021

VAERS ID: 1225311 Before After
VAERS Form:2
Age:68.0
Sex:Male
Location:North Carolina
Vaccinated:2021-03-15
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Pain in extremity, Physical examination, Peripheral swelling

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: Synthroid, Lexapro, Abilify, Senna-S, Miralax
Current Illness: Hypothyroidism, primary progressive aphasia.
Preexisting Conditions: Hypothyroidism, primary progressive aphasia.
Allergies: No known drug or food allergies. allergies.
Diagnostic Lab Data: UNABLE TO EVALUATE OTHER THAN PHYSICAL EXAM AT PATIENT HOME BY SUPPORTING MEDICAL TEAM.
CDC 'Split Type':

Write-up: SUDDEN ONSET OF SWELLING IN ENTIRE LEFT LOWER EXTREMITY ON APRIL 11, 2021. NO RECENT TRAUMA , CHANGE IN AMBULATORY STATUS OR CHANGE IN HYDRATION OR ORAL INTAKE.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1225311&WAYBACKHISTORY=ON


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