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This is VAERS ID 1184694

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1184694
VAERS Form:2
Age:32.0
Sex:Male
Location:Unknown
Vaccinated:2021-04-07
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: School      Purchased by: ??
Symptoms: Abdominal pain upper, Dizziness, Pain in extremity

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: Lisinopril and Citalopram
Current Illness: N/a
Preexisting Conditions: Obesity
Allergies: N/a
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Sore arm, light headed, stomach ache.


Changed on 5/7/2021

VAERS ID: 1184694 Before After
VAERS Form:2
Age:32.0
Sex:Male
Location:Unknown
Vaccinated:2021-04-07
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: School      Purchased by: ??
Symptoms: Abdominal pain upper, Dizziness, Pain in extremity

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: Lisinopril and Citalopram
Current Illness: N/a
Preexisting Conditions: Obesity
Allergies: N/a N/a
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Sore arm, light headed, stomach ache.


Changed on 5/14/2021

VAERS ID: 1184694 Before After
VAERS Form:2
Age:32.0
Sex:Male
Location:Unknown
Vaccinated:2021-04-07
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: School      Purchased by: ??
Symptoms: Abdominal pain upper, Dizziness, Pain in extremity

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: Lisinopril and Citalopram
Current Illness: N/a
Preexisting Conditions: Obesity
Allergies: N/a N/a
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Sore arm, light headed, stomach ache.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1184694&WAYBACKHISTORY=ON


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