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This is VAERS ID 1222436

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1222436
VAERS Form:2
Age:54.0
Sex:Male
Location:California
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Chills, Headache, Nausea

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: moderate fatigue, moderate pain at injection site, Influenza A vaccine, 54 years old, date approximately January 2021.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Bactrim
Diagnostic Lab Data: None.
CDC 'Split Type':

Write-up: Severe Chills on 11 April 2021 at 1:30 am, duration approximately 90 minutes. Self-administered ibuprofen. Resolved. Moderate to severe headache from 11 April 2021 to 12 April 2021. Treated with ibupofen. Resolved. Mild nausea, interrmittent from 11 April 2021 to 17 April 2021. Untreated, currently ongoing.


Changed on 5/7/2021

VAERS ID: 1222436 Before After
VAERS Form:2
Age:54.0
Sex:Male
Location:California
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Chills, Headache, Nausea

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: moderate fatigue, moderate pain at injection site, Influenza A vaccine, 54 years old, date approximately January 2021.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Bactrim Bactrim
Diagnostic Lab Data: None.
CDC 'Split Type':

Write-up: Severe Chills on 11 April 2021 at 1:30 am, duration approximately 90 minutes. Self-administered ibuprofen. Resolved. Moderate to severe headache from 11 April 2021 to 12 April 2021. Treated with ibupofen. Resolved. Mild nausea, interrmittent from 11 April 2021 to 17 April 2021. Untreated, currently ongoing.


Changed on 5/14/2021

VAERS ID: 1222436 Before After
VAERS Form:2
Age:54.0
Sex:Male
Location:California
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Chills, Headache, Nausea

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: moderate fatigue, moderate pain at injection site, Influenza A vaccine, 54 years old, date approximately January 2021.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Bactrim Bactrim
Diagnostic Lab Data: None.
CDC 'Split Type':

Write-up: Severe Chills on 11 April 2021 at 1:30 am, duration approximately 90 minutes. Self-administered ibuprofen. Resolved. Moderate to severe headache from 11 April 2021 to 12 April 2021. Treated with ibupofen. Resolved. Mild nausea, interrmittent from 11 April 2021 to 17 April 2021. Untreated, currently ongoing.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1222436&WAYBACKHISTORY=ON


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