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This is VAERS ID 1175560

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1175560
VAERS Form:2
Age:52.0
Sex:Male
Location:Florida
Vaccinated:2021-04-07
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Electrocardiogram, Erythema, Paraesthesia, Vital signs measurement, Pharyngeal paraesthesia

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? No
Previous Vaccinations: He disclosed a severe allergic reaction to the flu vaccine
Other Medications: Epi-Pen
Current Illness:
Preexisting Conditions: Adult Marfan Syndrome
Allergies: Iodine, Latex, Flu Vaccine
Diagnostic Lab Data: ECG, vital signs
CDC 'Split Type':

Write-up: Patient began feeling arm tingling, throat tingling, and had redness to arm and chest. Patient denies shortness of breath but has a severe history of allergic reactions that he did not communicate to provider prior to vaccine administration.


Changed on 5/7/2021

VAERS ID: 1175560 Before After
VAERS Form:2
Age:52.0
Sex:Male
Location:Florida
Vaccinated:2021-04-07
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Electrocardiogram, Erythema, Paraesthesia, Vital signs measurement, Pharyngeal paraesthesia

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? No
Previous Vaccinations: He disclosed a severe allergic reaction to the flu vaccine
Other Medications: Epi-Pen
Current Illness:
Preexisting Conditions: Adult Marfan Syndrome
Allergies: Iodine, Latex, Flu Vaccine Vaccine
Diagnostic Lab Data: ECG, vital signs
CDC 'Split Type':

Write-up: Patient began feeling arm tingling, throat tingling, and had redness to arm and chest. Patient denies shortness of breath but has a severe history of allergic reactions that he did not communicate to provider prior to vaccine administration.


Changed on 5/14/2021

VAERS ID: 1175560 Before After
VAERS Form:2
Age:52.0
Sex:Male
Location:Florida
Vaccinated:2021-04-07
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Electrocardiogram, Erythema, Paraesthesia, Vital signs measurement, Pharyngeal paraesthesia

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? No
Previous Vaccinations: He disclosed a severe allergic reaction to the flu vaccine
Other Medications: Epi-Pen
Current Illness:
Preexisting Conditions: Adult Marfan Syndrome
Allergies: Iodine, Latex, Flu Vaccine Vaccine
Diagnostic Lab Data: ECG, vital signs
CDC 'Split Type':

Write-up: Patient began feeling arm tingling, throat tingling, and had redness to arm and chest. Patient denies shortness of breath but has a severe history of allergic reactions that he did not communicate to provider prior to vaccine administration.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1175560&WAYBACKHISTORY=ON

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