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This is VAERS ID 1269669

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1269669
VAERS Form:2
Age:60.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-04-05
Onset:2021-04-18
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: Condition aggravated, Electromyogram abnormal, Full blood count abnormal, Generalised oedema, Guillain-Barre syndrome, Hypertension, Lumbar puncture abnormal, Respiratory distress, Musculoskeletal disorder, CSF test abnormal, Motor dysfunction

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, Prevacid , vitamin D,
Current Illness: None known
Preexisting Conditions: Hypertension, obesity, lymphedema, obstructive sleep apnea
Allergies: Amoxicillin
Diagnostic Lab Data: Abnormal EMG, abnormal CSF tap, abnormal CBC,
CDC 'Split Type':

Write-up: Guillain Barre syndrome. Severe progressive motor impairment upper and lower extremities. Respiratory distress severe widespread edema, hypertension increase,


Changed on 5/14/2021

VAERS ID: 1269669 Before After
VAERS Form:2
Age:60.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-04-05
Onset:2021-04-18
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Private      Purchased by: ??
Symptoms: Condition aggravated, Electromyogram abnormal, Full blood count abnormal, Generalised oedema, Guillain-Barre syndrome, Hypertension, Lumbar puncture abnormal, Respiratory distress, Musculoskeletal disorder, CSF test abnormal, Motor dysfunction

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? Yes, days: 9     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, Prevacid , vitamin D,
Current Illness: None known
Preexisting Conditions: Hypertension, obesity, lymphedema, obstructive sleep apnea
Allergies: Amoxicillin Amoxicillin
Diagnostic Lab Data: Abnormal EMG, abnormal CSF tap, abnormal CBC,
CDC 'Split Type':

Write-up: Guillain Barre syndrome. Severe progressive motor impairment upper and lower extremities. Respiratory distress severe widespread edema, hypertension increase,

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