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This is VAERS ID 1271589

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1271589
VAERS Form:2
Age:72.0
Sex:Female
Location:California
Vaccinated:2021-04-08
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Herpes virus infection, Disseminated varicella zoster virus infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Valtrex, gabapentin, levothyroid
Current Illness: HYPOTHYROIDISM HYPERLIPIDEMIA HX OF TOTAL HYSTERECTOMY SCREENING FOR COLORECTAL CANCER, AVERAGE RISK DECLINES VACCINATION DECLINES MAMMOGRAM SCREENING DISSEMINATED HERPES ZOSTER
Preexisting Conditions:
Allergies: Sulfur
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt developed a disseminated Zoster-kin lesions on 4/21


Changed on 5/7/2021

VAERS ID: 1271589 Before After
VAERS Form:2
Age:72.0
Sex:Female
Location:California
Vaccinated:2021-04-08
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Herpes virus infection, Disseminated varicella zoster virus infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Valtrex, gabapentin, levothyroid
Current Illness: HYPOTHYROIDISM HYPERLIPIDEMIA HX OF TOTAL HYSTERECTOMY SCREENING FOR COLORECTAL CANCER, AVERAGE RISK DECLINES VACCINATION DECLINES MAMMOGRAM SCREENING DISSEMINATED HERPES ZOSTER
Preexisting Conditions:
Allergies: Sulfur Sulfur
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt developed a disseminated Zoster-kin lesions on 4/21


Changed on 5/14/2021

VAERS ID: 1271589 Before After
VAERS Form:2
Age:72.0
Sex:Female
Location:California
Vaccinated:2021-04-08
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Herpes virus infection, Disseminated varicella zoster virus infection

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Valtrex, gabapentin, levothyroid
Current Illness: HYPOTHYROIDISM HYPERLIPIDEMIA HX OF TOTAL HYSTERECTOMY SCREENING FOR COLORECTAL CANCER, AVERAGE RISK DECLINES VACCINATION DECLINES MAMMOGRAM SCREENING DISSEMINATED HERPES ZOSTER
Preexisting Conditions:
Allergies: Sulfur Sulfur
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt developed a disseminated Zoster-kin lesions on 4/21

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1271589&WAYBACKHISTORY=ON


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