National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1170462

History of Changes from the VAERS Wayback Machine

First Appeared on 4/8/2021

VAERS ID: 1170462
VAERS Form:2
Age:56.0
Sex:Male
Location:Nevada
Vaccinated:2021-03-31
Onset:2021-04-05
Submitted:0000-00-00
Entered:2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Malaise, Rash, Rash erythematous, Rash macular, Rash papular

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-05
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: Naprosyn, Atenolol, Nitroglycerine, Tamsulosin, omeprazole, KCL, finesteride
Current Illness: Stasis dermatitis, GERD, HTN, chronic LBP.
Preexisting Conditions: HTN
Allergies: IBU, clindamycin, Bactrim, ASA, Robaxin,
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Presented with rash and malaise "since I got my COVID shot". Rash red raised macular t/o body


Changed on 5/7/2021

VAERS ID: 1170462 Before After
VAERS Form:2
Age:56.0
Sex:Male
Location:Nevada
Vaccinated:2021-03-31
Onset:2021-04-05
Submitted:0000-00-00
Entered:2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Malaise, Rash, Rash erythematous, Rash macular, Rash papular

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-05
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: Naprosyn, Atenolol, Nitroglycerine, Tamsulosin, omeprazole, KCL, finesteride
Current Illness: Stasis dermatitis, GERD, HTN, chronic LBP.
Preexisting Conditions: HTN
Allergies: IBU, clindamycin, Bactrim, ASA, Robaxin, Robaxin,
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Presented with rash and malaise "since I got my COVID shot". Rash red raised macular t/o body


Changed on 5/14/2021

VAERS ID: 1170462 Before After
VAERS Form:2
Age:56.0
Sex:Male
Location:Nevada
Vaccinated:2021-03-31
Onset:2021-04-05
Submitted:0000-00-00
Entered:2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Malaise, Rash, Rash erythematous, Rash macular, Rash papular

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-04-05
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: Naprosyn, Atenolol, Nitroglycerine, Tamsulosin, omeprazole, KCL, finesteride
Current Illness: Stasis dermatitis, GERD, HTN, chronic LBP.
Preexisting Conditions: HTN
Allergies: IBU, clindamycin, Bactrim, ASA, Robaxin, Robaxin,
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Presented with rash and malaise "since I got my COVID shot". Rash red raised macular t/o body

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1170462&WAYBACKHISTORY=ON


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