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This is VAERS ID 1230416

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1230416
VAERS Form:2
Age:85.0
Sex:Female
Location:New York
Vaccinated:2021-04-07
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Hypoaesthesia, Muscular weakness, Pain in extremity, Surgery, Thrombectomy, Angiogram abnormal, Arterial occlusive disease, Peripheral artery thrombosis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin, metformin, docusate
Current Illness: none
Preexisting Conditions: hypertension, hyperlipidemia, diabetes, dementia, atrial fibrillation, asthma, psoriasis
Allergies: duloxetine, penicillin
Diagnostic Lab Data: CT angiogram confirmed arterial occlusion
CDC 'Split Type':

Write-up: Presented with right hand/arm pain, numbness, and weakness since morning after receiving injection on ipsilateral side. Workup and imaging confirmed acute arterial thrombosis of the right upper extremity requiring surgery and thrombectomy.


Changed on 5/7/2021

VAERS ID: 1230416 Before After
VAERS Form:2
Age:85.0
Sex:Female
Location:New York
Vaccinated:2021-04-07
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Hypoaesthesia, Muscular weakness, Pain in extremity, Surgery, Thrombectomy, Angiogram abnormal, Arterial occlusive disease, Peripheral artery thrombosis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin, metformin, docusate
Current Illness: none
Preexisting Conditions: hypertension, hyperlipidemia, diabetes, dementia, atrial fibrillation, asthma, psoriasis
Allergies: duloxetine, penicillin penicillin
Diagnostic Lab Data: CT angiogram confirmed arterial occlusion
CDC 'Split Type':

Write-up: Presented with right hand/arm pain, numbness, and weakness since morning after receiving injection on ipsilateral side. Workup and imaging confirmed acute arterial thrombosis of the right upper extremity requiring surgery and thrombectomy.


Changed on 5/14/2021

VAERS ID: 1230416 Before After
VAERS Form:2
Age:85.0
Sex:Female
Location:New York
Vaccinated:2021-04-07
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Hypoaesthesia, Muscular weakness, Pain in extremity, Surgery, Thrombectomy, Angiogram abnormal, Arterial occlusive disease, Peripheral artery thrombosis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 7     Extended hospital stay? No
Previous Vaccinations:
Other Medications: aspirin, metformin, docusate
Current Illness: none
Preexisting Conditions: hypertension, hyperlipidemia, diabetes, dementia, atrial fibrillation, asthma, psoriasis
Allergies: duloxetine, penicillin penicillin
Diagnostic Lab Data: CT angiogram confirmed arterial occlusion
CDC 'Split Type':

Write-up: Presented with right hand/arm pain, numbness, and weakness since morning after receiving injection on ipsilateral side. Workup and imaging confirmed acute arterial thrombosis of the right upper extremity requiring surgery and thrombectomy.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1230416&WAYBACKHISTORY=ON

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