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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1236188



Case Details

VAERS ID: 1236188 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Arizona  
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Hypoaesthesia, Injection site discomfort, Injection site mass
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: XARELTO
Current Illness: Factor V Leiden mutation
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210427631

Write-up: LUMP AT THE INJECTION SITE (QUARTER SIZE OR BIGGER LUMP); DISCOMFORT AT INJECTION SITE; ARM/HAND NUMBNESS; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. The patient''s concurrent conditions included factor v leiden mutation. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1805020, expiry: UNKNOWN) dose was not reported, administered on 22-MAR-2021 for prophylactic vaccination. Concomitant medications included rivaroxaban for pulmonary embolism bilateral lungs, and deep vein thrombosis right side. On an unspecified date, the subject experienced lump at the injection site (quarter size or bigger lump), discomfort at injection site, and arm/hand numbness. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the lump at the injection site (quarter size or bigger lump), discomfort at injection site and arm/hand numbness was not reported. This report was non-serious.


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