National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 11/26/2021 release of VAERS data:

This is VAERS ID 1286779

Government Disclaimer on use of this data

Case Details

VAERS ID: 1286779 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Florida  
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-05-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Blood glucose normal, Electromyogram abnormal, Guillain-Barre syndrome, Hypoaesthesia, Paraesthesia, Protein total, Red blood cell count decreased, Restlessness, White blood cell count decreased
SMQs:, Rhabdomyolysis/myopathy (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (narrow), Peripheral neuropathy (narrow), Haemorrhage laboratory terms (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Dementia (broad), Akathisia (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Immune-mediated/autoimmune disorders (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EMG/NCS 4/23/2021 - Suggestive of an early/acute demyelinating polyradiculopathy. Abnormal/absent F responses, paraspinal fibrillations, conduction block/temporal dispersion maybe the only early signs at this point. CSF protein 148 CSF glucose 69 CSF wbc 2 in tube #1 CSF wbc 0 in tube #4 CSF rbc 21 in tube #1 CSF rbc 1 in tube #4
CDC Split Type:

Write-up: Guillain-Barre Syndrome - mild case. Tingling, numbness up entire legs more prominent in feet. Mild back pain. No weakness. Some numbness and paresthesias hands. Restlessness.

New Search

Link To This Search Result:

Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166