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This is VAERS ID 1236404

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1236404
VAERS Form:2
Age:
Sex:Male
Location:New Jersey
Vaccinated:0000-00-00
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Pain in extremity, Venous 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)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210436332

Write-up: VENOUS THROMBOSIS; PAIN IN LEFT LEG; This spontaneous report received from a consumer concerned a male of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 06-APR-2021 for prophylactic vaccination. Frequency was 1 total. Vaccination site was unspecified. No concomitant medications were reported. Batch number is not reported and has been requested. On 09-APR-2021, the patient experienced pain in left leg. On 16-APR-2021, he was diagnosed venous thrombosis, and he was hospitalized (date unspecified). Consumer told that currently patient was admitted when she called. Treatment to treat adverse event was not reported. Hospital name and address was not reported. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from venous thrombosis, and pain in left leg. This report was serious (Hospitalization Caused / Prolonged, and Other Medically Important Condition).; Sender''s Comments: V0: This is a spontaneous report of a male of unspecified age who developed a venous thrombosis and was hospitalized 10 days after receiving the Janssen COVID-19 vaccine. No medical history, concomitant medications or additional details were reported. Additional information has been requested. The case will be assessed further when additional information is received.


Changed on 5/7/2021

VAERS ID: 1236404 Before After
VAERS Form:2
Age:
Sex:Male
Location:New Jersey
Vaccinated:0000-00-00
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Pain in extremity, Venous 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)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210436332

Write-up: VENOUS THROMBOSIS; PAIN IN LEFT LEG; This spontaneous report received from a consumer concerned a male of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 06-APR-2021 for prophylactic vaccination. Frequency was 1 total. Vaccination site was unspecified. No concomitant medications were reported. Batch number is not reported and has been requested. On 09-APR-2021, the patient experienced pain in left leg. On 16-APR-2021, he was diagnosed venous thrombosis, and he was hospitalized (date unspecified). Consumer told that currently patient was admitted when she called. Treatment to treat adverse event was not reported. Hospital name and address was not reported. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from venous thrombosis, and pain in left leg. This report was serious (Hospitalization Caused / Prolonged, and Other Medically Important Condition).; Sender''s Comments: V0: This is a spontaneous report of a male of unspecified age who developed a venous thrombosis and was hospitalized 10 days after receiving the Janssen COVID-19 vaccine. No medical history, concomitant medications or additional details were reported. Additional information has been requested. The case will be assessed further when additional information is received.


Changed on 5/14/2021

VAERS ID: 1236404 Before After
VAERS Form:2
Age:
Sex:Male
Location:New Jersey
Vaccinated:0000-00-00
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Pain in extremity, Venous 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)? No
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210436332

Write-up: VENOUS THROMBOSIS; PAIN IN LEFT LEG; This spontaneous report received from a consumer concerned a male of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 06-APR-2021 for prophylactic vaccination. Frequency was 1 total. Vaccination site was unspecified. No concomitant medications were reported. Batch number is not reported and has been requested. On 09-APR-2021, the patient experienced pain in left leg. On 16-APR-2021, he was diagnosed venous thrombosis, and he was hospitalized (date unspecified). Consumer told that currently patient was admitted when she called. Treatment to treat adverse event was not reported. Hospital name and address was not reported. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from venous thrombosis, and pain in left leg. This report was serious (Hospitalization Caused / Prolonged, and Other Medically Important Condition).; Sender''s Comments: V0: This is a spontaneous report of a male of unspecified age who developed a venous thrombosis and was hospitalized 10 days after receiving the Janssen COVID-19 vaccine. No medical history, concomitant medications or additional details were reported. Additional information has been requested. The case will be assessed further when additional information is received.

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