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This is VAERS ID 1191213

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1191213
VAERS Form:2
Age:49.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-04-08
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Hypersensitivity, Deep vein thrombosis

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Depression
Allergies: Bee Stings
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: systemic reaction followed by deep vein thrombosis


Changed on 5/7/2021

VAERS ID: 1191213 Before After
VAERS Form:2
Age:49.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-04-08
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Hypersensitivity, Deep vein thrombosis

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Depression
Allergies: Bee Stings Stings
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: systemic reaction followed by deep vein thrombosis


Changed on 5/14/2021

VAERS ID: 1191213 Before After
VAERS Form:2
Age:49.0
Sex:Male
Location:Pennsylvania
Vaccinated:2021-04-08
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Hypersensitivity, Deep vein thrombosis

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Depression
Allergies: Bee Stings Stings
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: systemic reaction followed by deep vein thrombosis

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1191213&WAYBACKHISTORY=ON

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