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This is VAERS ID 1231260

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1231260
VAERS Form:2
Age:38.0
Sex:Female
Location:Texas
Vaccinated:2021-04-06
Onset:2021-04-17
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / N/A LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cerebral venous sinus thrombosis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Nothing reported
Preexisting Conditions: Unknown
Allergies: NKDA
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: I was contacted by physician assistant who informed us that patient was at HCF being treated for clotting believed to be secondary to having received the Janssen Covid19 vaccination. He said that she was diagnosed as having a focal dural venous thrombosis in the superior sagittal sinus and was being treated with Eliquis. He requested that we report this event to VAERS.


Changed on 5/7/2021

VAERS ID: 1231260 Before After
VAERS Form:2
Age:38.0
Sex:Female
Location:Texas
Vaccinated:2021-04-06
Onset:2021-04-17
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / N/A LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cerebral venous sinus thrombosis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Nothing reported
Preexisting Conditions: Unknown
Allergies: NKDA NKDA
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: I was contacted by physician assistant who informed us that patient was at HCF being treated for clotting believed to be secondary to having received the Janssen Covid19 vaccination. He said that she was diagnosed as having a focal dural venous thrombosis in the superior sagittal sinus and was being treated with Eliquis. He requested that we report this event to VAERS.


Changed on 5/14/2021

VAERS ID: 1231260 Before After
VAERS Form:2
Age:38.0
Sex:Female
Location:Texas
Vaccinated:2021-04-06
Onset:2021-04-17
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / N/A LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cerebral venous sinus thrombosis

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Nothing reported
Preexisting Conditions: Unknown
Allergies: NKDA NKDA
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: I was contacted by physician assistant who informed us that patient was at HCF being treated for clotting believed to be secondary to having received the Janssen Covid19 vaccination. He said that she was diagnosed as having a focal dural venous thrombosis in the superior sagittal sinus and was being treated with Eliquis. He requested that we report this event to VAERS.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1231260&WAYBACKHISTORY=ON

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