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This is VAERS ID 1240163

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1240163
VAERS Form:2
Age:28.0
Sex:Female
Location:California
Vaccinated:2021-04-08
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 RA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Pyrexia, Rash

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: Albuterol
Current Illness: None
Preexisting Conditions: Athsma
Allergies: None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Minor fever 48 hours post injection; acne-like rash across upper back and shoulders 11 days post-injection. Rash almost gone 14 days post-injection.


Changed on 5/7/2021

VAERS ID: 1240163 Before After
VAERS Form:2
Age:28.0
Sex:Female
Location:California
Vaccinated:2021-04-08
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 RA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Pyrexia, Rash

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: Albuterol
Current Illness: None
Preexisting Conditions: Athsma
Allergies: None None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Minor fever 48 hours post injection; acne-like rash across upper back and shoulders 11 days post-injection. Rash almost gone 14 days post-injection.


Changed on 5/14/2021

VAERS ID: 1240163 Before After
VAERS Form:2
Age:28.0
Sex:Female
Location:California
Vaccinated:2021-04-08
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 RA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Pyrexia, Rash

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: Albuterol
Current Illness: None
Preexisting Conditions: Athsma
Allergies: None None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Minor fever 48 hours post injection; acne-like rash across upper back and shoulders 11 days post-injection. Rash almost gone 14 days post-injection.

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