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This is VAERS ID 1231570

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1231570
VAERS Form:2
Age:24.0
Sex:Male
Location:California
Vaccinated:2021-04-19
Onset:2021-04-20
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Chills, Headache, Injection site pain, Myalgia, Pain, Pyrexia

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: Serataline, Ibuprofen,
Current Illness:
Preexisting Conditions: SVT - Supraventriculartachicardia (heart condition)
Allergies: Demerol
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Chills, fever, muscle/body ache, headache, pain at injection point. Took Ibuprofen


Changed on 5/7/2021

VAERS ID: 1231570 Before After
VAERS Form:2
Age:24.0
Sex:Male
Location:California
Vaccinated:2021-04-19
Onset:2021-04-20
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Chills, Headache, Injection site pain, Myalgia, Pain, Pyrexia

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: Serataline, Ibuprofen,
Current Illness:
Preexisting Conditions: SVT - Supraventriculartachicardia (heart condition)
Allergies: Demerol Demerol
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Chills, fever, muscle/body ache, headache, pain at injection point. Took Ibuprofen


Changed on 5/14/2021

VAERS ID: 1231570 Before After
VAERS Form:2
Age:24.0
Sex:Male
Location:California
Vaccinated:2021-04-19
Onset:2021-04-20
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Chills, Headache, Injection site pain, Myalgia, Pain, Pyrexia

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: Serataline, Ibuprofen,
Current Illness:
Preexisting Conditions: SVT - Supraventriculartachicardia (heart condition)
Allergies: Demerol Demerol
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Chills, fever, muscle/body ache, headache, pain at injection point. Took Ibuprofen

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1231570&WAYBACKHISTORY=ON


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