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This is VAERS ID 1261343

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1261343
VAERS Form:2
Age:
Sex:Female
Location:Massachusetts
Vaccinated:0000-00-00
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Fatigue, Headache, Injection site erythema, Malaise, Movement disorder, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210442743

Write-up: LIMITED USE OF LEFT ARM; SORE LEFT ARM; MALAISE; INJECTION SITE REDNESS; FATIGUE; HEADACHE; This spontaneous report received from a patient concerned a female 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, intramuscular, batch number: Unknown) dose was not reported, administered on 11-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 11-APR-2021, the subject experienced fatigue. On 11-APR-2021, the subject experienced sore arm. On 11-APR-2021, the subject experienced arm tenderness. On 11-APR-2021, the subject experienced limited use of left arm. On 11-APR-2021, the subject experienced injection site redness. On 11-APR-2021, the subject experienced malaise. On 11-APR-2021, the subject experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not reported. The outcome of the fatigue, sore arm, arm tenderness, limited use of left arm, injection site redness, malaise and headache was not reported. This report was non-serious.


Changed on 5/7/2021

VAERS ID: 1261343 Before After
VAERS Form:2
Age:
Sex:Female
Location:Massachusetts
Vaccinated:0000-00-00
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Fatigue, Headache, Injection site erythema, Malaise, Movement disorder, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210442743

Write-up: LIMITED USE OF LEFT ARM; SORE LEFT ARM; MALAISE; INJECTION SITE REDNESS; FATIGUE; HEADACHE; This spontaneous report received from a patient concerned a female 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, intramuscular, batch number: Unknown) dose was not reported, administered on 11-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 11-APR-2021, the subject experienced fatigue. On 11-APR-2021, the subject experienced sore arm. On 11-APR-2021, the subject experienced arm tenderness. On 11-APR-2021, the subject experienced limited use of left arm. On 11-APR-2021, the subject experienced injection site redness. On 11-APR-2021, the subject experienced malaise. On 11-APR-2021, the subject experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not reported. The outcome of the fatigue, sore arm, arm tenderness, limited use of left arm, injection site redness, malaise and headache was not reported. This report was non-serious.


Changed on 5/14/2021

VAERS ID: 1261343 Before After
VAERS Form:2
Age:
Sex:Female
Location:Massachusetts
Vaccinated:0000-00-00
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Fatigue, Headache, Injection site erythema, Malaise, Movement disorder, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210442743

Write-up: LIMITED USE OF LEFT ARM; SORE LEFT ARM; MALAISE; INJECTION SITE REDNESS; FATIGUE; HEADACHE; This spontaneous report received from a patient concerned a female 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, intramuscular, batch number: Unknown) dose was not reported, administered on 11-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 11-APR-2021, the subject experienced fatigue. On 11-APR-2021, the subject experienced sore arm. On 11-APR-2021, the subject experienced arm tenderness. On 11-APR-2021, the subject experienced limited use of left arm. On 11-APR-2021, the subject experienced injection site redness. On 11-APR-2021, the subject experienced malaise. On 11-APR-2021, the subject experienced headache. The action taken with covid-19 vaccine ad26.cov2.s was not reported. The outcome of the fatigue, sore arm, arm tenderness, limited use of left arm, injection site redness, malaise and headache was not reported. This report was non-serious.

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