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This is VAERS ID 1186043

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1186043
VAERS Form:2
Age:59.0
Sex:Female
Location:Missouri
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 203A21A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: No adverse event

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: linsin, baclofen, insulin, novalog
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: unknown, not provided


Changed on 5/7/2021

VAERS ID: 1186043 Before After
VAERS Form:2
Age:59.0
Sex:Female
Location:Missouri
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 203A21A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: No adverse event

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: linsin, baclofen, insulin, novalog
Current Illness: none
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: unknown, not provided


Changed on 5/14/2021

VAERS ID: 1186043 Before After
VAERS Form:2
Age:59.0
Sex:Female
Location:Missouri
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 203A21A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: No adverse event

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: linsin, baclofen, insulin, novalog
Current Illness: none
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: unknown, not provided

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1186043&WAYBACKHISTORY=ON


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