National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1130843

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1130843
VAERS Form:2
Age:62.0
Sex:Male
Location:Unknown
Vaccinated:2021-03-24
Onset:2021-03-24
Submitted:0000-00-00
Entered:2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Extra dose administered, No adverse event

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

Write-up: Patient stated that he wanted a vaccine today while staff were in the unit. He denied receiving it prior. He was given the vaccine and upon documenting it was discovered that he receive the Modern vaccine 1st dose on 2/2/21 and 2nd dose on 3/2/21. Today he received Jannsen dose. He has no adverse effects and no complaints.


Changed on 5/7/2021

VAERS ID: 1130843 Before After
VAERS Form:2
Age:62.0
Sex:Male
Location:Unknown
Vaccinated:2021-03-24
Onset:2021-03-24
Submitted:0000-00-00
Entered:2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Extra dose administered, No adverse event

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

Write-up: Patient stated that he wanted a vaccine today while staff were in the unit. He denied receiving it prior. He was given the vaccine and upon documenting it was discovered that he receive the Modern vaccine 1st dose on 2/2/21 and 2nd dose on 3/2/21. Today he received Jannsen dose. He has no adverse effects and no complaints.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1130843&WAYBACKHISTORY=ON


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