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From the 6/4/2021 release of VAERS data:

This is VAERS ID 1257027



Case Details

VAERS ID: 1257027 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Female  
Location: Colorado  
Vaccinated:2021-04-11
Onset:2021-04-12
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Adverse reaction, Nausea, Tremor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: IBUPROFEN 800MG, GABAPENTIN 100MG, TRIMETHOPRIM100MG, ONDANSETRON 8 MG, TRAZODONE 150MG, ATORVASTATIN 40MG , DIAZEPAM 5 MG, PEPTOBISMOL
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: SULFA
Diagnostic Lab Data: UNKNOWN
CDC Split Type:

Write-up: ON 4/25/21, PT STOPPED AT PHARMACY COMPLAINING OF ADVERSE REACTIONS SHE WAS HAVING DUE TO THE JOHNSON AND JOHNSON VACCINE SHE GOT. SHE C/O NAUSEA AND HANDS SHAKING. I TOLD HER I WOULD SUBMIT A REPORTAND FOR HER TO SEEK TREATMENT FROM HER PCP. I ASKED THAT SHE CONTACT ME WITH ANY CONCERNS OR SHARE COMMENTS THAT DR SHARES WITH HER.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1257027


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