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This is VAERS ID 1246503

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1246503
VAERS Form:2
Age:17.0
Sex:Male
Location:North Carolina
Vaccinated:2021-04-12
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 RA / IM

Administered by: Private      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? 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: Flovent, Simvastatin, Zyrtec, and Ventolin
Current Illness: Hyperlipidemia
Preexisting Conditions: Asthma
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient given vaccine at 17 years and 8 months of age when he should have been 18. No adverse effects noted day of vaccine or following day when staff called to check on him.


Changed on 5/7/2021

VAERS ID: 1246503 Before After
VAERS Form:2
Age:17.0
Sex:Male
Location:North Carolina
Vaccinated:2021-04-12
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 RA / IM

Administered by: Private      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? 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: Flovent, Simvastatin, Zyrtec, and Ventolin
Current Illness: Hyperlipidemia
Preexisting Conditions: Asthma
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient given vaccine at 17 years and 8 months of age when he should have been 18. No adverse effects noted day of vaccine or following day when staff called to check on him.


Changed on 5/14/2021

VAERS ID: 1246503 Before After
VAERS Form:2
Age:17.0
Sex:Male
Location:North Carolina
Vaccinated:2021-04-12
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 RA / IM

Administered by: Private      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? 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: Flovent, Simvastatin, Zyrtec, and Ventolin
Current Illness: Hyperlipidemia
Preexisting Conditions: Asthma
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient given vaccine at 17 years and 8 months of age when he should have been 18. No adverse effects noted day of vaccine or following day when staff called to check on him.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1246503&WAYBACKHISTORY=ON


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