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This is VAERS ID 1184618

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1184618
VAERS Form:2
Age:17.0
Sex:Female
Location:Michigan
Vaccinated:2021-04-09
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Product administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: n/a
Current Illness: n.a
Preexisting Conditions: na
Allergies: n/a
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient was 17 at time of injection, under the age agreed upon for EUA


Changed on 5/7/2021

VAERS ID: 1184618 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Michigan
Vaccinated:2021-04-09
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Product administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: n/a
Current Illness: n.a
Preexisting Conditions: na
Allergies: n/a n/a
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient was 17 at time of injection, under the age agreed upon for EUA


Changed on 5/14/2021

VAERS ID: 1184618 Before After
VAERS Form:2
Age:17.0
Sex:Female
Location:Michigan
Vaccinated:2021-04-09
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Product administered to patient of inappropriate age

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: n/a
Current Illness: n.a
Preexisting Conditions: na
Allergies: n/a n/a
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient was 17 at time of injection, under the age agreed upon for EUA

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1184618&WAYBACKHISTORY=ON


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