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This is VAERS ID 1481231

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History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1481231
VAERS Form:2
Age:
Sex:Male
Location:Indiana
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Guillain-Barre syndrome

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type': USJNJFOC20210728662

Write-up: GUILLAIN-BARRE SYNDROME; This spontaneous report was received from a consumer (bother-in-law of the patient) and concerned a male patient in his 60''s of unspecified race and ethnicity. The patient''s height and weight were not reported. The patient''s past medical history was not reported. The patient received COVID-19 vaccine Ad26.CoV2.S (suspension for injection, route of administration unknown, batch number unknown), dose, vaccination site, and vaccination date not reported, once in total, for prophylactic vaccination. Batch number was not reported. Company will conduct follow up to obtain batch number. No concomitant medications were reported. On an unspecified date, the patient experienced Guillain-Barre syndrome. The action taken with COVID-19 vaccine Ad26.CoV2.S was not applicable. The outcome of Guillain-Barre syndrome was not reported. This report was serious (other medically important condition).; Sender''s Comments: V0: This spontaneous report received from the brother-in-law of the patient concerns a male in his 7th decade of life who experienced Guillain-Barre Syndrome an unspecified period of time after receiving the Janssen Covid-19 vaccine. Medical history, concomitant medications, clinical symptoms, diagnostic testing, corrective treatment, and outcome were not reported. The relationship of the event to vaccination is considered unclassifiable due to insufficient information. Additional information will be requested.

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