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This is VAERS ID 1136967

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1136967
VAERS Form:2
Age:53.0
Sex:Male
Location:Ohio
Vaccinated:2021-03-25
Onset:2021-03-25
Submitted:0000-00-00
Entered:2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Public      Purchased by: ??
Symptoms: Chills, Headache, Nausea, Retching, Hot flush

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: Lisinopril hctz One a day men''s 50+
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: Coconut
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Headache 6 hours after shot lasting 24 hours Chills and hot flashes unabated Nausea and dry heaves


Changed on 5/7/2021

VAERS ID: 1136967 Before After
VAERS Form:2
Age:53.0
Sex:Male
Location:Ohio
Vaccinated:2021-03-25
Onset:2021-03-25
Submitted:0000-00-00
Entered:2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Public      Purchased by: ??
Symptoms: Chills, Headache, Nausea, Retching, Hot flush

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: Lisinopril hctz One a day men''s 50+
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: Coconut Coconut
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Headache 6 hours after shot lasting 24 hours Chills and hot flashes unabated Nausea and dry heaves

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1136967&WAYBACKHISTORY=ON


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