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This is VAERS ID 1237372

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1237372
VAERS Form:2
Age:62.0
Sex:Male
Location:Minnesota
Vaccinated:2021-03-25
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808975 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trulicity; Metformin; Atorvastatin; Zyrtec; ASA; MVI; Tamsulosin
Current Illness: No
Preexisting Conditions: Diabetes
Allergies: PCN
Diagnostic Lab Data: Covid Naso Pharyngeal swab Positive
CDC 'Split Type':

Write-up: Diagnosed with Covid on 4/20/2021, more than 2 weeks after receiving


Changed on 5/7/2021

VAERS ID: 1237372 Before After
VAERS Form:2
Age:62.0
Sex:Male
Location:Minnesota
Vaccinated:2021-03-25
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808975 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trulicity; Metformin; Atorvastatin; Zyrtec; ASA; MVI; Tamsulosin
Current Illness: No
Preexisting Conditions: Diabetes
Allergies: PCN PCN
Diagnostic Lab Data: Covid Naso Pharyngeal swab Positive
CDC 'Split Type':

Write-up: Diagnosed with Covid on 4/20/2021, more than 2 weeks after receiving


Changed on 5/14/2021

VAERS ID: 1237372 Before After
VAERS Form:2
Age:62.0
Sex:Male
Location:Minnesota
Vaccinated:2021-03-25
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808975 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: COVID-19, SARS-CoV-2 test positive

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Trulicity; Metformin; Atorvastatin; Zyrtec; ASA; MVI; Tamsulosin
Current Illness: No
Preexisting Conditions: Diabetes
Allergies: PCN PCN
Diagnostic Lab Data: Covid Naso Pharyngeal swab Positive
CDC 'Split Type':

Write-up: Diagnosed with Covid on 4/20/2021, more than 2 weeks after receiving

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