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This is VAERS ID 1230196

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1230196
VAERS Form:2
Age:44.0
Sex:Female
Location:Kansas
Vaccinated:2021-03-20
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Pain in extremity, Thrombophlebitis, Ultrasound scan abnormal

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: Adderall, Clindamycin, Crestor, Tri Femynor (birth control)
Current Illness: None
Preexisting Conditions: Hyperlipidemia, long QT syndrome and Attention deficit disorder
Allergies: NKDA
Diagnostic Lab Data: U/S 4/19/21
CDC 'Split Type':

Write-up: pt had left upper arm pain and found on ultrasound 4/19/21 to have a superficial thrombophlebitis


Changed on 5/7/2021

VAERS ID: 1230196 Before After
VAERS Form:2
Age:44.0
Sex:Female
Location:Kansas
Vaccinated:2021-03-20
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Pain in extremity, Thrombophlebitis, Ultrasound scan abnormal

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: Adderall, Clindamycin, Crestor, Tri Femynor (birth control)
Current Illness: None
Preexisting Conditions: Hyperlipidemia, long QT syndrome and Attention deficit disorder
Allergies: NKDA NKDA
Diagnostic Lab Data: U/S 4/19/21
CDC 'Split Type':

Write-up: pt had left upper arm pain and found on ultrasound 4/19/21 to have a superficial thrombophlebitis


Changed on 5/14/2021

VAERS ID: 1230196 Before After
VAERS Form:2
Age:44.0
Sex:Female
Location:Kansas
Vaccinated:2021-03-20
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Pain in extremity, Thrombophlebitis, Ultrasound scan abnormal

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: Adderall, Clindamycin, Crestor, Tri Femynor (birth control)
Current Illness: None
Preexisting Conditions: Hyperlipidemia, long QT syndrome and Attention deficit disorder
Allergies: NKDA NKDA
Diagnostic Lab Data: U/S 4/19/21
CDC 'Split Type':

Write-up: pt had left upper arm pain and found on ultrasound 4/19/21 to have a superficial thrombophlebitis

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1230196&WAYBACKHISTORY=ON


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