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This is VAERS ID 1264039

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1264039
VAERS Form:2
Age:65.0
Sex:Male
Location:Alabama
Vaccinated:2021-03-17
Onset:2021-04-18
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Ataxia, Guillain-Barre syndrome, Lumbar puncture abnormal, Immunoglobulin therapy, Magnetic resonance imaging spinal normal, Magnetic resonance imaging head normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Omepraozole, Naproxen, Tadalafil, Atorvastatin, Aspirin
Current Illness: None
Preexisting Conditions: Hypertension, coronary artery disease, hypothyroidism
Allergies: None
Diagnostic Lab Data: MRI Lumbar Spine, MRI Brain, Lumbar Puncture
CDC 'Split Type':

Write-up: Patient developed ataxic gait determined to be Guillan-Barre syndrome. Was treated with course of IVIg with improvement but not resolution.


Changed on 5/7/2021

VAERS ID: 1264039 Before After
VAERS Form:2
Age:65.0
Sex:Male
Location:Alabama
Vaccinated:2021-03-17
Onset:2021-04-18
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Ataxia, Guillain-Barre syndrome, Lumbar puncture abnormal, Immunoglobulin therapy, Magnetic resonance imaging spinal normal, Magnetic resonance imaging head normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Omepraozole, Naproxen, Tadalafil, Atorvastatin, Aspirin
Current Illness: None
Preexisting Conditions: Hypertension, coronary artery disease, hypothyroidism
Allergies: None None
Diagnostic Lab Data: MRI Lumbar Spine, MRI Brain, Lumbar Puncture
CDC 'Split Type':

Write-up: Patient developed ataxic gait determined to be Guillan-Barre syndrome. Was treated with course of IVIg with improvement but not resolution.


Changed on 5/14/2021

VAERS ID: 1264039 Before After
VAERS Form:2
Age:65.0
Sex:Male
Location:Alabama
Vaccinated:2021-03-17
Onset:2021-04-18
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Ataxia, Guillain-Barre syndrome, Lumbar puncture abnormal, Immunoglobulin therapy, Magnetic resonance imaging spinal normal, Magnetic resonance imaging head normal

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 8     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Omepraozole, Naproxen, Tadalafil, Atorvastatin, Aspirin
Current Illness: None
Preexisting Conditions: Hypertension, coronary artery disease, hypothyroidism
Allergies: None None
Diagnostic Lab Data: MRI Lumbar Spine, MRI Brain, Lumbar Puncture
CDC 'Split Type':

Write-up: Patient developed ataxic gait determined to be Guillan-Barre syndrome. Was treated with course of IVIg with improvement but not resolution.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1264039&WAYBACKHISTORY=ON


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