National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 9/10/2021 release of VAERS data:

This is VAERS ID 1474610



Case Details

VAERS ID: 1474610 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-07-01
Onset:2021-07-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Arthralgia, Asthenia, Inflammation, Injection site pain, Joint range of motion decreased, Limb injury, Loss of personal independence in daily activities, Product administered at inappropriate site, Shoulder injury related to vaccine administration, X-ray
SMQs:, Dementia (broad), Drug abuse and dependence (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Arthritis (broad), Tendinopathies and ligament disorders (broad), Medication errors (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Metoprolol 200 mg once daily Lisinopril 10 mg once daily Pantoprazole 10 mg once daily Montelukast 10 mg once daily Methimazole 10 mg once daily Trazadone 50 mg as needed for sleep Vitamin D3 5000 IU 3x week Lutein 25 mg once daily
Current Illness: None
Preexisting Conditions: Cardio myopathy (rapid heartbeat) hyper-thyroid
Allergies: None
Diagnostic Lab Data: Had an appointment on July 15, 2021 with my primary care provider. I was diagnosed with Shoulder Injury Related to Vaccine Administration (SIRVA). They did an X-Ray (no results yet), and prescribed a short-term dose of steroids. Will have follow-up appointment in mid-August, and may possibly need an MRI and/or Physical Therapy.
CDC Split Type:

Write-up: The injection was given into the shoulder joint rather than the deltoid muscle. This has resulted in an inflammatory process that has caused pain and injury to my left shoulder (e.g., tendons, ligaments, bursae, nerves). I now have persistent shoulder and upper arm pain, weakness, and limited range of motion that has worsened in the two weeks following the injection. I am dealing with chronic shoulder and upper arm pain, and am unable to carry out daily activities that were not an issue prior to vaccination. When the symptoms did not subside, I sought medical treatment from my primary care provider on July 15, 2021.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1474610


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