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This is VAERS ID 1184841

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1184841
VAERS Form:2
Age:18.0
Sex:Male
Location:Ohio
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 1808982 / 1 - / IM

Administered by: Other      Purchased by: ??
Symptoms: Anaphylactic reaction

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Epi pen used
CDC 'Split Type': 21080

Write-up: anaphylaxis


Changed on 5/7/2021

VAERS ID: 1184841 Before After
VAERS Form:2
Age:18.0
Sex:Male
Location:Ohio
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 1808982 / 1 - / IM

Administered by: Other      Purchased by: ??
Symptoms: Anaphylactic reaction

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data: Epi pen used
CDC 'Split Type': 21080

Write-up: anaphylaxis


Changed on 5/14/2021

VAERS ID: 1184841 Before After
VAERS Form:2
Age:18.0
Sex:Male
Location:Ohio
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 1808982 / 1 - / IM

Administered by: Other      Purchased by: ??
Symptoms: Anaphylactic reaction

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data: Epi pen used
CDC 'Split Type': 21080

Write-up: anaphylaxis

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1184841&WAYBACKHISTORY=ON


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