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This is VAERS ID 1181828

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1181828
VAERS Form:2
Age:12.0
Sex:Male
Location:Arkansas
Vaccinated:2021-04-02
Onset:2021-04-04
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Swollen tongue

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: not know
Current Illness: not known
Preexisting Conditions: not known
Allergies: not known
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Patient was given vaccine at Community Outreach event on 04/2/21. Mother was contacted on 4/6/21 concerning incomplete name on her consent. She advised that her son received the covvid vaccine and had gone to the ER on 4/6/21 with a swollen tongue. She stated that he was treated with Tylenol and Benadryl and released to come home that day. Spoke with mom on 4/7/21 and she stated that the patient was stable and his entire tongue was not swollen just a small area. She denied any issues with his airway or breathing from time of vaccine to time of follow up call.


Changed on 5/7/2021

VAERS ID: 1181828 Before After
VAERS Form:2
Age:12.0
Sex:Male
Location:Arkansas
Vaccinated:2021-04-02
Onset:2021-04-04
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Swollen tongue

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: not know
Current Illness: not known
Preexisting Conditions: not known
Allergies: not known known
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Patient was given vaccine at Community Outreach event on 04/2/21. Mother was contacted on 4/6/21 concerning incomplete name on her consent. She advised that her son received the covvid vaccine and had gone to the ER on 4/6/21 with a swollen tongue. She stated that he was treated with Tylenol and Benadryl and released to come home that day. Spoke with mom on 4/7/21 and she stated that the patient was stable and his entire tongue was not swollen just a small area. She denied any issues with his airway or breathing from time of vaccine to time of follow up call.


Changed on 5/14/2021

VAERS ID: 1181828 Before After
VAERS Form:2
Age:12.0
Sex:Male
Location:Arkansas
Vaccinated:2021-04-02
Onset:2021-04-04
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Swollen tongue

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: not know
Current Illness: not known
Preexisting Conditions: not known
Allergies: not known known
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Patient was given vaccine at Community Outreach event on 04/2/21. Mother was contacted on 4/6/21 concerning incomplete name on her consent. She advised that her son received the covvid vaccine and had gone to the ER on 4/6/21 with a swollen tongue. She stated that he was treated with Tylenol and Benadryl and released to come home that day. Spoke with mom on 4/7/21 and she stated that the patient was stable and his entire tongue was not swollen just a small area. She denied any issues with his airway or breathing from time of vaccine to time of follow up call.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1181828&WAYBACKHISTORY=ON


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