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This is VAERS ID 1213406

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1213406
VAERS Form:2
Age:79.0
Sex:Male
Location:California
Vaccinated:2021-04-05
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Computerised tomogram, Facial pain, Hypoaesthesia, Pain of skin, X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: CARVEDILOL, RAMIPRIL
Current Illness: N/A
Preexisting Conditions: HEART CONDITION..HE WAS ON COREG AND RAMIPRIL ACCORDING TO HIS LETTER
Allergies: NO KNOWN
Diagnostic Lab Data: heart X ray CAT scan
CDC 'Split Type':

Write-up: 4/5/21 vaccinated 4/7/21 numbed face.,right side from nose to ear and from upper lip to top of scalp. painful face and scalp like a severe burn.


Changed on 5/7/2021

VAERS ID: 1213406 Before After
VAERS Form:2
Age:79.0
Sex:Male
Location:California
Vaccinated:2021-04-05
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Computerised tomogram, Facial pain, Hypoaesthesia, Pain of skin, X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: CARVEDILOL, RAMIPRIL
Current Illness: N/A
Preexisting Conditions: HEART CONDITION..HE WAS ON COREG AND RAMIPRIL ACCORDING TO HIS LETTER
Allergies: NO KNOWN KNOWN
Diagnostic Lab Data: heart X ray CAT scan
CDC 'Split Type':

Write-up: 4/5/21 vaccinated 4/7/21 numbed face.,right side from nose to ear and from upper lip to top of scalp. painful face and scalp like a severe burn.


Changed on 5/14/2021

VAERS ID: 1213406 Before After
VAERS Form:2
Age:79.0
Sex:Male
Location:California
Vaccinated:2021-04-05
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Computerised tomogram, Facial pain, Hypoaesthesia, Pain of skin, X-ray

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: CARVEDILOL, RAMIPRIL
Current Illness: N/A
Preexisting Conditions: HEART CONDITION..HE WAS ON COREG AND RAMIPRIL ACCORDING TO HIS LETTER
Allergies: NO KNOWN KNOWN
Diagnostic Lab Data: heart X ray CAT scan
CDC 'Split Type':

Write-up: 4/5/21 vaccinated 4/7/21 numbed face.,right side from nose to ear and from upper lip to top of scalp. painful face and scalp like a severe burn.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1213406&WAYBACKHISTORY=ON

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