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This is VAERS ID 1230057

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1230057
VAERS Form:2
Age:68.0
Sex:Male
Location:California
Vaccinated:2021-04-07
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / UN

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain, Full blood count, Headache, Pain, Urine analysis, Vision blurred, Abdominal X-ray

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Labs : routine chemistry, CBC differential, UA Macroscopic, XR acute abdomen series ( 4/14/2021)
CDC 'Split Type':

Write-up: Headache, diffuse abdominal pain , recent blurred vision lasting 1 week


Changed on 5/7/2021

VAERS ID: 1230057 Before After
VAERS Form:2
Age:68.0
Sex:Male
Location:California
Vaccinated:2021-04-07
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / UN

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain, Full blood count, Headache, Pain, Urine analysis, Vision blurred, Abdominal X-ray

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A N/A
Diagnostic Lab Data: Labs : routine chemistry, CBC differential, UA Macroscopic, XR acute abdomen series ( 4/14/2021)
CDC 'Split Type':

Write-up: Headache, diffuse abdominal pain , recent blurred vision lasting 1 week


Changed on 5/14/2021

VAERS ID: 1230057 Before After
VAERS Form:2
Age:68.0
Sex:Male
Location:California
Vaccinated:2021-04-07
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / UN

Administered by: Private      Purchased by: ??
Symptoms: Abdominal pain, Full blood count, Headache, Pain, Urine analysis, Vision blurred, Abdominal X-ray

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A N/A
Diagnostic Lab Data: Labs : routine chemistry, CBC differential, UA Macroscopic, XR acute abdomen series ( 4/14/2021)
CDC 'Split Type':

Write-up: Headache, diffuse abdominal pain , recent blurred vision lasting 1 week

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1230057&WAYBACKHISTORY=ON


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