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This is VAERS ID 1228392

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1228392
VAERS Form:2
Age:59.0
Sex:Male
Location:Indiana
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / N/A LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Chills, Fatigue, Headache, Injection site pain, Pain

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: Lisinopril HCTZ 25 mg tablet one per day Levothyroxine 125 MCG tablet one per day Astorvastatin 40 MG one tablet per day Multivitamin
Current Illness: N/A
Preexisting Conditions: Hypertension Elevated cholesterol
Allergies: Melon fruits Banana
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: 24 hours after injection Pain at injection site Chills Body Aches Headache Fatigue


Changed on 5/7/2021

VAERS ID: 1228392 Before After
VAERS Form:2
Age:59.0
Sex:Male
Location:Indiana
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / N/A LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Chills, Fatigue, Headache, Injection site pain, Pain

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: Lisinopril HCTZ 25 mg tablet one per day Levothyroxine 125 MCG tablet one per day Astorvastatin 40 MG one tablet per day Multivitamin
Current Illness: N/A
Preexisting Conditions: Hypertension Elevated cholesterol
Allergies: Melon fruits Banana Banana
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: 24 hours after injection Pain at injection site Chills Body Aches Headache Fatigue


Changed on 5/14/2021

VAERS ID: 1228392 Before After
VAERS Form:2
Age:59.0
Sex:Male
Location:Indiana
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / N/A LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Chills, Fatigue, Headache, Injection site pain, Pain

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: Lisinopril HCTZ 25 mg tablet one per day Levothyroxine 125 MCG tablet one per day Astorvastatin 40 MG one tablet per day Multivitamin
Current Illness: N/A
Preexisting Conditions: Hypertension Elevated cholesterol
Allergies: Melon fruits Banana Banana
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: 24 hours after injection Pain at injection site Chills Body Aches Headache Fatigue

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1228392&WAYBACKHISTORY=ON


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