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This is VAERS ID 1249240

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1249240
VAERS Form:2
Age:40.0
Sex:Female
Location:North Carolina
Vaccinated:0000-00-00
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Military      Purchased by: ??
Symptoms: Chest discomfort, Headache

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? No
Previous Vaccinations:
Other Medications: CONTRACEPTIVES
Current Illness: Non-smoker
Preexisting Conditions: Medical History/Concurrent Conditions: Basilar artery thrombosis; Vertebral artery thrombosis; Comments: No illicit use of drugs.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210427724

Write-up: CHEST TIGHTNESS; INTERMITTENT HEADACHES; This spontaneous report received from a patient concerned a 40 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included basilar artery thrombosis, and vertebral artery thrombosis, and concurrent conditions included non-smoker, and other pre-existing medical conditions included no illicit use of drugs. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported) dose was not reported, administered on 10-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. Concomitant medications included . On 12-APR-2021, the subject experienced chest tightness. On 12-APR-2021, the subject experienced intermittent headaches. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from intermittent headaches, and chest tightness. This report was non-serious.; Sender''s Comments: V0; MAC Comment is not required for non serious case as per standard protocol.


Changed on 5/7/2021

VAERS ID: 1249240 Before After
VAERS Form:2
Age:40.0
Sex:Female
Location:North Carolina
Vaccinated:0000-00-00
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Military      Purchased by: ??
Symptoms: Chest discomfort, Headache

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? No
Previous Vaccinations:
Other Medications: CONTRACEPTIVES
Current Illness: Non-smoker
Preexisting Conditions: Medical History/Concurrent Conditions: Basilar artery thrombosis; Vertebral artery thrombosis; Comments: No illicit use of drugs.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210427724

Write-up: CHEST TIGHTNESS; INTERMITTENT HEADACHES; This spontaneous report received from a patient concerned a 40 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included basilar artery thrombosis, and vertebral artery thrombosis, and concurrent conditions included non-smoker, and other pre-existing medical conditions included no illicit use of drugs. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported) dose was not reported, administered on 10-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. Concomitant medications included . On 12-APR-2021, the subject experienced chest tightness. On 12-APR-2021, the subject experienced intermittent headaches. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from intermittent headaches, and chest tightness. This report was non-serious.; Sender''s Comments: V0; MAC Comment is not required for non serious case as per standard protocol.


Changed on 5/14/2021

VAERS ID: 1249240 Before After
VAERS Form:2
Age:40.0
Sex:Female
Location:North Carolina
Vaccinated:0000-00-00
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Military      Purchased by: ??
Symptoms: Chest discomfort, Headache

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? No
Previous Vaccinations:
Other Medications: CONTRACEPTIVES
Current Illness: Non-smoker
Preexisting Conditions: Medical History/Concurrent Conditions: Basilar artery thrombosis; Vertebral artery thrombosis; Comments: No illicit use of drugs.
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210427724

Write-up: CHEST TIGHTNESS; INTERMITTENT HEADACHES; This spontaneous report received from a patient concerned a 40 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included basilar artery thrombosis, and vertebral artery thrombosis, and concurrent conditions included non-smoker, and other pre-existing medical conditions included no illicit use of drugs. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported) dose was not reported, administered on 10-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. Concomitant medications included . On 12-APR-2021, the subject experienced chest tightness. On 12-APR-2021, the subject experienced intermittent headaches. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from intermittent headaches, and chest tightness. This report was non-serious.; Sender''s Comments: V0; MAC Comment is not required for non serious case as per standard protocol.

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