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This is VAERS ID 1269931

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1269931
VAERS Form:2
Age:23.0
Sex:Female
Location:New Hampshire
Vaccinated:0000-00-00
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Back pain, Chills, Genital rash, Haematochezia, Headache, Pain, Pyrexia

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: patient had no known allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210432632

Write-up: BLOOD IN STOOL; RASH ON FANNY; CHILLS; FEVER; HEADACHE; BODY ACHES; BACK ACHE; This spontaneous report received from a parent concerned a 23 year old, white, and not Hispanic or Latino female. The patient''s height, and weight were not reported. The patient had no known allergies. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, one total, 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 patient had body aches, chills, fever, headache and backache (low back pain). On 12-APR-2021, Monday, she felt better but experienced backache again on 13-APR-2021, Tuesday and felt better later that day. On 14-APR-2021, at night she had weird rash on fanny and also had lower back pain. On 15-APR-2021 morning, she had blood in stool and again experienced backache (pain in the lower back). The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from body aches, chills, fever, and headache on 13-APR-2021, and had not recovered from back ache, rash on fanny, and blood in stool. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210432632-Covid-19 vaccine ad26.cov2.s -Blood in stool. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


Changed on 5/7/2021

VAERS ID: 1269931 Before After
VAERS Form:2
Age:23.0
Sex:Female
Location:New Hampshire
Vaccinated:0000-00-00
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Back pain, Chills, Genital rash, Haematochezia, Headache, Pain, Pyrexia

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: patient had no known allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210432632

Write-up: BLOOD IN STOOL; RASH ON FANNY; CHILLS; FEVER; HEADACHE; BODY ACHES; BACK ACHE; This spontaneous report received from a parent concerned a 23 year old, white, and not Hispanic or Latino female. The patient''s height, and weight were not reported. The patient had no known allergies. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, one total, 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 patient had body aches, chills, fever, headache and backache (low back pain). On 12-APR-2021, Monday, she felt better but experienced backache again on 13-APR-2021, Tuesday and felt better later that day. On 14-APR-2021, at night she had weird rash on fanny and also had lower back pain. On 15-APR-2021 morning, she had blood in stool and again experienced backache (pain in the lower back). The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from body aches, chills, fever, and headache on 13-APR-2021, and had not recovered from back ache, rash on fanny, and blood in stool. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210432632-Covid-19 vaccine ad26.cov2.s -Blood in stool. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


Changed on 5/14/2021

VAERS ID: 1269931 Before After
VAERS Form:2
Age:23.0
Sex:Female
Location:New Hampshire
Vaccinated:0000-00-00
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Back pain, Chills, Genital rash, Haematochezia, Headache, Pain, Pyrexia

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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: patient had no known allergies
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210432632

Write-up: BLOOD IN STOOL; RASH ON FANNY; CHILLS; FEVER; HEADACHE; BODY ACHES; BACK ACHE; This spontaneous report received from a parent concerned a 23 year old, white, and not Hispanic or Latino female. The patient''s height, and weight were not reported. The patient had no known allergies. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, one total, 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 patient had body aches, chills, fever, headache and backache (low back pain). On 12-APR-2021, Monday, she felt better but experienced backache again on 13-APR-2021, Tuesday and felt better later that day. On 14-APR-2021, at night she had weird rash on fanny and also had lower back pain. On 15-APR-2021 morning, she had blood in stool and again experienced backache (pain in the lower back). The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from body aches, chills, fever, and headache on 13-APR-2021, and had not recovered from back ache, rash on fanny, and blood in stool. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210432632-Covid-19 vaccine ad26.cov2.s -Blood in stool. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).

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