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This is VAERS ID 1230410

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1230410
VAERS Form:2
Age:65.0
Sex:Female
Location:New York
Vaccinated:2021-03-16
Onset:2021-04-04
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Asthenia, Dysarthria, Dysphagia, Epistaxis, Guillain-Barre syndrome, Headache, Mastication disorder, Myalgia, Pain in extremity

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? Yes, days: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: diabetes, heart disease
Allergies: egg whites
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Patient had slurred speech, headache, pain in the thigh muscles, bloody nose, lost strength in the arms, hands and legs, could not chew or swallow. She was diagnosed with Guillian Barre Syndrome and hospitalized from 04/04/2021-04/18/2021.


Changed on 5/7/2021

VAERS ID: 1230410 Before After
VAERS Form:2
Age:65.0
Sex:Female
Location:New York
Vaccinated:2021-03-16
Onset:2021-04-04
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Asthenia, Dysarthria, Dysphagia, Epistaxis, Guillain-Barre syndrome, Headache, Mastication disorder, Myalgia, Pain in extremity

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? Yes, days: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: diabetes, heart disease
Allergies: egg whites whites
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Patient had slurred speech, headache, pain in the thigh muscles, bloody nose, lost strength in the arms, hands and legs, could not chew or swallow. She was diagnosed with Guillian Barre Syndrome and hospitalized from 04/04/2021-04/18/2021.


Changed on 5/14/2021

VAERS ID: 1230410 Before After
VAERS Form:2
Age:65.0
Sex:Female
Location:New York
Vaccinated:2021-03-16
Onset:2021-04-04
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Asthenia, Dysarthria, Dysphagia, Epistaxis, Guillain-Barre syndrome, Headache, Mastication disorder, Myalgia, Pain in extremity

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? Yes, days: 14     Extended hospital stay? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: diabetes, heart disease
Allergies: egg whites whites
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: Patient had slurred speech, headache, pain in the thigh muscles, bloody nose, lost strength in the arms, hands and legs, could not chew or swallow. She was diagnosed with Guillian Barre Syndrome and hospitalized from 04/04/2021-04/18/2021.

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