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This is VAERS ID 1178409

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1178409
VAERS Form:2
Age:27.0
Sex:Male
Location:Missouri
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 042A21A / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Abdominal pain, Computerised tomogram

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:
Other Medications: None
Current Illness: No other illnesses at the time
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: CT 4/7/2021
CDC 'Split Type':

Write-up: Patient got home after vaccination and said he was having abdominal cramping. He is getting a CT at the hospital and will report results


Changed on 5/7/2021

VAERS ID: 1178409 Before After
VAERS Form:2
Age:27.0
Sex:Male
Location:Missouri
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 042A21A / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Abdominal pain, Computerised tomogram

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:
Other Medications: None
Current Illness: No other illnesses at the time
Preexisting Conditions: None
Allergies: NKDA NKDA
Diagnostic Lab Data: CT 4/7/2021
CDC 'Split Type':

Write-up: Patient got home after vaccination and said he was having abdominal cramping. He is getting a CT at the hospital and will report results


Changed on 5/14/2021

VAERS ID: 1178409 Before After
VAERS Form:2
Age:27.0
Sex:Male
Location:Missouri
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 042A21A / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Abdominal pain, Computerised tomogram

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:
Other Medications: None
Current Illness: No other illnesses at the time
Preexisting Conditions: None
Allergies: NKDA NKDA
Diagnostic Lab Data: CT 4/7/2021
CDC 'Split Type':

Write-up: Patient got home after vaccination and said he was having abdominal cramping. He is getting a CT at the hospital and will report results

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1178409&WAYBACKHISTORY=ON

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