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This is VAERS ID 1231141

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1231141
VAERS Form:2
Age:33.0
Sex:Female
Location:Illinois
Vaccinated:0000-00-00
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Unevaluable event

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: ADDERAL
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NUTS
Diagnostic Lab Data: PLEASE SEE ATTACHED DOCTORS NOTES AND TESTS RESULTS
CDC 'Split Type':

Write-up: PLEASE SEE ATTACHED DOCTORS NOTES AND TEST RESULTS


Changed on 5/7/2021

VAERS ID: 1231141 Before After
VAERS Form:2
Age:33.0
Sex:Female
Location:Illinois
Vaccinated:0000-00-00
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Unevaluable event

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: ADDERAL
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NUTS NUTS
Diagnostic Lab Data: PLEASE SEE ATTACHED DOCTORS NOTES AND TESTS RESULTS
CDC 'Split Type':

Write-up: PLEASE SEE ATTACHED DOCTORS NOTES AND TEST RESULTS


Changed on 5/14/2021

VAERS ID: 1231141 Before After
VAERS Form:2
Age:33.0
Sex:Female
Location:Illinois
Vaccinated:0000-00-00
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Unevaluable event

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: ADDERAL
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NUTS NUTS
Diagnostic Lab Data: PLEASE SEE ATTACHED DOCTORS NOTES AND TESTS RESULTS
CDC 'Split Type':

Write-up: PLEASE SEE ATTACHED DOCTORS NOTES AND TEST RESULTS

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1231141&WAYBACKHISTORY=ON


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