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This is VAERS ID 1082037

History of Changes from the VAERS Wayback Machine

First Appeared on 3/11/2021

VAERS ID: 1082037
VAERS Form:2
Age:80.0
Sex:Male
Location:Ohio
Vaccinated:2021-03-06
Onset:2021-03-07
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Malaise

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)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: PANTOPRAZOLE 40MG, AMLODIPINE 5MG, HYDRALAZINE 50MG, SODIUM BICARB 650MG
Current Illness:
Preexisting Conditions: MYELOMA, TYPE 2 DIABETES, KIDNEY DISEASE
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PATIENT''S WIFE STATED THAT HE HAD SYMPTOMS SIMILAR TO COVID AND WAS ADMITTED INTO THE HOSPITAL.


Changed on 5/7/2021

VAERS ID: 1082037 Before After
VAERS Form:2
Age:80.0
Sex:Male
Location:Ohio
Vaccinated:2021-03-06
Onset:2021-03-07
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Malaise

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)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: PANTOPRAZOLE 40MG, AMLODIPINE 5MG, HYDRALAZINE 50MG, SODIUM BICARB 650MG
Current Illness:
Preexisting Conditions: MYELOMA, TYPE 2 DIABETES, KIDNEY DISEASE
Allergies: NO KNOWN ALLERGIES ALLERGIES
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PATIENT''S WIFE STATED THAT HE HAD SYMPTOMS SIMILAR TO COVID AND WAS ADMITTED INTO THE HOSPITAL.


Changed on 5/14/2021

VAERS ID: 1082037 Before After
VAERS Form:2
Age:80.0
Sex:Male
Location:Ohio
Vaccinated:2021-03-06
Onset:2021-03-07
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Malaise

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)? Yes
Hospitalized? Yes, days: 2     Extended hospital stay? No
Previous Vaccinations:
Other Medications: PANTOPRAZOLE 40MG, AMLODIPINE 5MG, HYDRALAZINE 50MG, SODIUM BICARB 650MG
Current Illness:
Preexisting Conditions: MYELOMA, TYPE 2 DIABETES, KIDNEY DISEASE
Allergies: NO KNOWN ALLERGIES ALLERGIES
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PATIENT''S WIFE STATED THAT HE HAD SYMPTOMS SIMILAR TO COVID AND WAS ADMITTED INTO THE HOSPITAL.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1082037&WAYBACKHISTORY=ON


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