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This is VAERS ID 1257027

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1257027
VAERS Form:2
Age:68.0
Sex:Female
Location:Colorado
Vaccinated:2021-04-11
Onset:2021-04-12
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: Nausea, Tremor, Adverse reaction

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)? 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.


Changed on 5/7/2021

VAERS ID: 1257027 Before After
VAERS Form:2
Age:68.0
Sex:Female
Location:Colorado
Vaccinated:2021-04-11
Onset:2021-04-12
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: Nausea, Tremor, Adverse reaction

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)? 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 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.


Changed on 5/14/2021

VAERS ID: 1257027 Before After
VAERS Form:2
Age:68.0
Sex:Female
Location:Colorado
Vaccinated:2021-04-11
Onset:2021-04-12
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: Nausea, Tremor, Adverse reaction

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)? 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 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&WAYBACKHISTORY=ON


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