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This is VAERS ID 899504

History of Changes from the VAERS Wayback Machine

First Appeared on 5/7/2021

VAERS ID: 899504
VAERS Form:2
Age:61.0
Sex:Female
Location:Michigan
Vaccinated:2020-11-18
Onset:2020-11-21
Submitted:0000-00-00
Entered:2020-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS J2N44 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Bell's palsy, Drooling, Ear pain, Physical examination, Facial paresis, Ear discomfort, Hypoaesthesia oral, Jaw disorder

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: Amitriptyline hcl 25mg tab - Take one tablet PO Q BEDTIME Amlodipine besylate 5mg tab - Take one tablet PO DAILY Aspirin tab,ec - 81MG PO DAILY Epinephrine (eqv-epi-pen) 0.3mg/0.3ml - Inject syringe IM Levothyroxine na (synthroid) 175mcg ta
Current Illness: none
Preexisting Conditions: History of thyroid cancer, cholelithiasis, hypertension, cervical cancer
Allergies: Local Allergies: BEE STINGS (ANAPHYLAXIS), PEANUT BUTTER (ANAPHYLAXIS)
Diagnostic Lab Data: physical exam only
CDC 'Split Type':

Write-up: The patient received recombinant zoster vaccine (RZV) 0.5 ml IM in Left deltoid. Manufacturer: GlaxoSmithKline Lot#s and Expiration Date: Vial#1-J2N44 Exp-05/17/2022 Vial#2-7TB74 Exp-05/17/2022 Complications: None at time of the injections. ON NOV22 (plus or minus) patient experienced ear pain and pressure, called nursing triage on November 24 reporting ear pain and ear pressure, numb lips, jaw numbness and drooling and was found to have left lower facial muscle weakness diag w/left sided Bells Palsy


Changed on 5/14/2021

VAERS ID: 899504 Before After
VAERS Form:2
Age:61.0
Sex:Female
Location:Michigan
Vaccinated:2020-11-18
Onset:2020-11-21
Submitted:0000-00-00
Entered:2020-12-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
VARZOS: ZOSTER (SHINGRIX) / GLAXOSMITHKLINE BIOLOGICALS J2N44 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Bell's palsy, Drooling, Ear pain, Physical examination, Facial paresis, Ear discomfort, Hypoaesthesia oral, Jaw disorder

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: Amitriptyline hcl 25mg tab - Take one tablet PO Q BEDTIME Amlodipine besylate 5mg tab - Take one tablet PO DAILY Aspirin tab,ec - 81MG PO DAILY Epinephrine (eqv-epi-pen) 0.3mg/0.3ml - Inject syringe IM Levothyroxine na (synthroid) 175mcg ta
Current Illness: none
Preexisting Conditions: History of thyroid cancer, cholelithiasis, hypertension, cervical cancer
Allergies: Local Allergies: BEE STINGS (ANAPHYLAXIS), PEANUT BUTTER (ANAPHYLAXIS) (ANAPHYLAXIS)
Diagnostic Lab Data: physical exam only
CDC 'Split Type':

Write-up: The patient received recombinant zoster vaccine (RZV) 0.5 ml IM in Left deltoid. Manufacturer: GlaxoSmithKline Lot#s and Expiration Date: Vial#1-J2N44 Exp-05/17/2022 Vial#2-7TB74 Exp-05/17/2022 Complications: None at time of the injections. ON NOV22 (plus or minus) patient experienced ear pain and pressure, called nursing triage on November 24 reporting ear pain and ear pressure, numb lips, jaw numbness and drooling and was found to have left lower facial muscle weakness diag w/left sided Bells Palsy

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https://www.medalerts.org/vaersdb/findfield.php?IDNUMBER=899504&WAYBACKHISTORY=ON


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