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This is VAERS ID 1432815

History of Changes from the VAERS Wayback Machine

First Appeared on 7/2/2021

VAERS ID: 1432815
VAERS Form:2
Age:51.0
Sex:Female
Location:California
Vaccinated:0000-00-00
Onset:2021-06-20
Submitted:0000-00-00
Entered:2021-06-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain, Computerised tomogram, Headache, Pain in extremity, Thrombosis

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: VALSARTAN
Current Illness:
Preexisting Conditions: Comments: The patient was not pregnant at the time of reporting.
Allergies:
Diagnostic Lab Data: Test Date: 20210620; Test Name: CAT scan; Result Unstructured Data: Blood clots observed in right femoral vein in the right thigh.
CDC 'Split Type': USJNJFOC20210654370

Write-up: ABDOMINAL PAIN; LEG PAIN; HEADACHE; BLOOD CLOT IN THE RIGHT FEMORAL VEIN IN THE RIGHT THIGH; This spontaneous report received from a consumer concerned a 51 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included the patient was not pregnant at the time of reporting. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 043A21A, and expiry: UNKNOWN) dose was not reported, 1 total administered on 03-APR-2021 to right deltoid for prophylactic vaccination. Concomitant medications included valsartan 40mg. On 20-JUN-2021, the patient experienced blood clot in the right femoral vein in the right thigh which was found through computerised tomogram which was done when the patient had visited the doctor about the other symptoms of abdominal pain, leg pain and headaches. The health care professional had intended to visit another health care professional specialized in blood clot related issues. Laboratory data included: Computerised tomogram scan (NR: not provided) Blood clots observed in right femoral vein in the right thigh. On an unspecified date, the patient experienced abdominal pain, leg pain, and headache. Treatment medications (dates unspecified) included: paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of the blood clot in the right femoral vein in the right thigh, leg pain, headache and abdominal pain was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210654370-COVID-19 VACCINE AD26.COV2.S-blood clot in the right femoral vein in the right thigh. 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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