National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1234008

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1234008
VAERS Form:2
Age:16.0
Sex:Male
Location:Minnesota
Vaccinated:2021-04-11
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: No adverse event, Product administered to patient of inappropriate age

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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patients guardian falsified DOB when registering for vaccination, stating the minor''s DOB was 07/06/2002. Guardian, consented to the vaccination. Department of Health verified with statistical records that the patients actual DOB is 07/06/2004 which made the vaccine a contraindication. No known adverse reactions noted.


Changed on 5/7/2021

VAERS ID: 1234008 Before After
VAERS Form:2
Age:16.0
Sex:Male
Location:Minnesota
Vaccinated:2021-04-11
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: No adverse event, Product administered to patient of inappropriate age

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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patients guardian falsified DOB when registering for vaccination, stating the minor''s DOB was 07/06/2002. Guardian, consented to the vaccination. Department of Health verified with statistical records that the patients actual DOB is 07/06/2004 which made the vaccine a contraindication. No known adverse reactions noted.


Changed on 5/14/2021

VAERS ID: 1234008 Before After
VAERS Form:2
Age:16.0
Sex:Male
Location:Minnesota
Vaccinated:2021-04-11
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: No adverse event, Product administered to patient of inappropriate age

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:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patients guardian falsified DOB when registering for vaccination, stating the minor''s DOB was 07/06/2002. Guardian, consented to the vaccination. Department of Health verified with statistical records that the patients actual DOB is 07/06/2004 which made the vaccine a contraindication. No known adverse reactions noted.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1234008&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166