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This is VAERS ID 1262677

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1262677
VAERS Form:2
Age:55.0
Sex:Female
Location:New York
Vaccinated:2021-04-08
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Pain, Pyrexia, Rash, Sinus congestion, Upper-airway cough syndrome

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? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Dexlansoprazole and spironolactone
Current Illness:
Preexisting Conditions: GERD, hypertension
Allergies: Sulfa - rash. Penicillins -unknown reaction
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had a fever of 101 status post vaccine with body aches, rash to the left chest, sinus congestion and post-nasal drip. Symptoms started about 3 days after vaccine administration. Patient is currently inpatient


Changed on 5/7/2021

VAERS ID: 1262677 Before After
VAERS Form:2
Age:55.0
Sex:Female
Location:New York
Vaccinated:2021-04-08
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Pain, Pyrexia, Rash, Sinus congestion, Upper-airway cough syndrome

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? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Dexlansoprazole and spironolactone
Current Illness:
Preexisting Conditions: GERD, hypertension
Allergies: Sulfa - rash. Penicillins -unknown reaction reaction
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had a fever of 101 status post vaccine with body aches, rash to the left chest, sinus congestion and post-nasal drip. Symptoms started about 3 days after vaccine administration. Patient is currently inpatient


Changed on 5/14/2021

VAERS ID: 1262677 Before After
VAERS Form:2
Age:55.0
Sex:Female
Location:New York
Vaccinated:2021-04-08
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Pain, Pyrexia, Rash, Sinus congestion, Upper-airway cough syndrome

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? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Dexlansoprazole and spironolactone
Current Illness:
Preexisting Conditions: GERD, hypertension
Allergies: Sulfa - rash. Penicillins -unknown reaction reaction
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient had a fever of 101 status post vaccine with body aches, rash to the left chest, sinus congestion and post-nasal drip. Symptoms started about 3 days after vaccine administration. Patient is currently inpatient

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1262677&WAYBACKHISTORY=ON


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