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This is VAERS ID 1250896

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1250896
VAERS Form:2
Age:69.0
Sex:Male
Location:New Jersey
Vaccinated:2021-04-06
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain, Chest discomfort, Chest X-ray normal, Dizziness, Dyspnoea, Electrocardiogram normal, Fatigue, Headache, Lip swelling, Nausea, Ultrasound Doppler, Peripheral swelling, Computerised tomogram head

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations: Flu
Other Medications: Atorvastatin, Exetimibe, Omeprazole, Flonase
Current Illness:
Preexisting Conditions: Gastritis, glaucoma, arthritis.
Allergies: Penicillin
Diagnostic Lab Data: Went to ER on 04/15 where they did US Doppler Venous Lower Extremity ; results negative. Also did EKG which was "normal". Headache continued so went back to ER on 04/17 where they did a EKG (normal), Chest X-ray (normal) and a CT Head without contrast (determined no clots). Was given Toradol and Reglan. Those drugs calmed my headache and I started to feel better. Slight headache ret 04/24.
CDC 'Split Type':

Write-up: Started 1 week after injection. Swelling in lower legs, felt like balloons. Feeling of swelling in lips. Headache started in left temple area of head; after a couple of days went across forehead and on back of head with intensity increasing but not extreme pain. Slight nausea; no vomiting. Some abdominal pain that would come and go. Periods of shortness of breath; tightness feeling in upper chest. Loss of energy and some light headed feeling.


Changed on 5/7/2021

VAERS ID: 1250896 Before After
VAERS Form:2
Age:69.0
Sex:Male
Location:New Jersey
Vaccinated:2021-04-06
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain, Chest discomfort, Chest X-ray normal, Dizziness, Dyspnoea, Electrocardiogram normal, Fatigue, Headache, Lip swelling, Nausea, Ultrasound Doppler, Peripheral swelling, Computerised tomogram head

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations: Flu
Other Medications: Atorvastatin, Exetimibe, Omeprazole, Flonase
Current Illness:
Preexisting Conditions: Gastritis, glaucoma, arthritis.
Allergies: Penicillin Penicillin
Diagnostic Lab Data: Went to ER on 04/15 where they did US Doppler Venous Lower Extremity ; results negative. Also did EKG which was "normal". Headache continued so went back to ER on 04/17 where they did a EKG (normal), Chest X-ray (normal) and a CT Head without contrast (determined no clots). Was given Toradol and Reglan. Those drugs calmed my headache and I started to feel better. Slight headache ret 04/24.
CDC 'Split Type':

Write-up: Started 1 week after injection. Swelling in lower legs, felt like balloons. Feeling of swelling in lips. Headache started in left temple area of head; after a couple of days went across forehead and on back of head with intensity increasing but not extreme pain. Slight nausea; no vomiting. Some abdominal pain that would come and go. Periods of shortness of breath; tightness feeling in upper chest. Loss of energy and some light headed feeling.


Changed on 5/14/2021

VAERS ID: 1250896 Before After
VAERS Form:2
Age:69.0
Sex:Male
Location:New Jersey
Vaccinated:2021-04-06
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain, Chest discomfort, Chest X-ray normal, Dizziness, Dyspnoea, Electrocardiogram normal, Fatigue, Headache, Lip swelling, Nausea, Ultrasound Doppler, Peripheral swelling, Computerised tomogram head

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations: Flu
Other Medications: Atorvastatin, Exetimibe, Omeprazole, Flonase
Current Illness:
Preexisting Conditions: Gastritis, glaucoma, arthritis.
Allergies: Penicillin Penicillin
Diagnostic Lab Data: Went to ER on 04/15 where they did US Doppler Venous Lower Extremity ; results negative. Also did EKG which was "normal". Headache continued so went back to ER on 04/17 where they did a EKG (normal), Chest X-ray (normal) and a CT Head without contrast (determined no clots). Was given Toradol and Reglan. Those drugs calmed my headache and I started to feel better. Slight headache ret 04/24.
CDC 'Split Type':

Write-up: Started 1 week after injection. Swelling in lower legs, felt like balloons. Feeling of swelling in lips. Headache started in left temple area of head; after a couple of days went across forehead and on back of head with intensity increasing but not extreme pain. Slight nausea; no vomiting. Some abdominal pain that would come and go. Periods of shortness of breath; tightness feeling in upper chest. Loss of energy and some light headed feeling.

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