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This is VAERS ID 1272105

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 1272105
VAERS Form:2
Age:62.0
Sex:Female
Location:California
Vaccinated:2021-04-09
Onset:2021-04-16
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: CSF protein normal, Guillain-Barre syndrome, Muscular weakness, Immunoglobulin therapy

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)? Yes
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Trazodone, Alprazolam, Percocet
Current Illness:
Preexisting Conditions: CHF, Restrictive lung disease, depression, chronic pain, gastroparesis, interstitial cystitis, chronic headaches.
Allergies: Zyprexa, Elavil, DHE, Imitrex, Talwin, Nubain, Xyrem, Lexapro, mirtazapine, stadol, sulfa, prochloperazine, sumatriptan, metoclopramide, sodium oxybate, meperidine, morphine
Diagnostic Lab Data: CSF negative for protein elevation.
CDC 'Split Type':

Write-up: Guillain Barre Syndrome. Leg weakness one week following vaccine. Hospitalized. Treated with IVIG. Improved with leg weakness only sequela.


Changed on 5/14/2021

VAERS ID: 1272105 Before After
VAERS Form:2
Age:62.0
Sex:Female
Location:California
Vaccinated:2021-04-09
Onset:2021-04-16
Submitted:0000-00-00
Entered:2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: CSF protein normal, Guillain-Barre syndrome, Muscular weakness, Immunoglobulin therapy

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)? Yes
Hospitalized? Yes, days: 6     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Trazodone, Alprazolam, Percocet
Current Illness:
Preexisting Conditions: CHF, Restrictive lung disease, depression, chronic pain, gastroparesis, interstitial cystitis, chronic headaches.
Allergies: Zyprexa, Elavil, DHE, Imitrex, Talwin, Nubain, Xyrem, Lexapro, mirtazapine, stadol, sulfa, prochloperazine, sumatriptan, metoclopramide, sodium oxybate, meperidine, morphine morphine
Diagnostic Lab Data: CSF negative for protein elevation.
CDC 'Split Type':

Write-up: Guillain Barre Syndrome. Leg weakness one week following vaccine. Hospitalized. Treated with IVIG. Improved with leg weakness only sequela.

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