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This is VAERS ID 1263112

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1263112
VAERS Form:2
Age:33.0
Sex:Female
Location:Florida
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 20121A / N/A RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Headache, Pain in extremity

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: lyme disease, headache, arthralgia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: From patient to after hours provider with c/o head and leg pain after Johnson & Johnson CVD19 vaccine. She states symptoms started 24 hours after vaccine and has not resolved. Patient advised to proceed to the nearest ER for evaluation for potential side effect due to J&J vaccine. Patient states understanding.


Changed on 5/7/2021

VAERS ID: 1263112 Before After
VAERS Form:2
Age:33.0
Sex:Female
Location:Florida
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 20121A / N/A RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Headache, Pain in extremity

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: lyme disease, headache, arthralgia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: From patient to after hours provider with c/o head and leg pain after Johnson & Johnson CVD19 vaccine. She states symptoms started 24 hours after vaccine and has not resolved. Patient advised to proceed to the nearest ER for evaluation for potential side effect due to J&J vaccine. Patient states understanding.


Changed on 5/14/2021

VAERS ID: 1263112 Before After
VAERS Form:2
Age:33.0
Sex:Female
Location:Florida
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 20121A / N/A RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Headache, Pain in extremity

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: none
Preexisting Conditions: lyme disease, headache, arthralgia
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: From patient to after hours provider with c/o head and leg pain after Johnson & Johnson CVD19 vaccine. She states symptoms started 24 hours after vaccine and has not resolved. Patient advised to proceed to the nearest ER for evaluation for potential side effect due to J&J vaccine. Patient states understanding.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1263112&WAYBACKHISTORY=ON


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