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This is VAERS ID 1474610

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1474610
VAERS Form:2
Age:60.0
Sex:Female
Location:Tennessee
Vaccinated:2021-07-01
Onset:2021-07-01
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, Injection site pain, X-ray, Joint range of motion decreased, Inflammation, Limb injury, Loss of personal independence in daily activities, Product administered at inappropriate site, Shoulder injury related to vaccine administration

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: 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.

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