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This is VAERS ID 1248849

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1248849
VAERS Form:2
Age:37.0
Sex:Male
Location:Michigan
Vaccinated:2021-04-08
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Headache, Visual impairment

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: None, other than tea (ginger, cinnamon, black tea)
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: None. Does not have insurance or care provider. Will look for care that is free.
CDC 'Split Type':

Write-up: Severe headache x 5 days affecting ability to see and complete daily activities


Changed on 5/7/2021

VAERS ID: 1248849 Before After
VAERS Form:2
Age:37.0
Sex:Male
Location:Michigan
Vaccinated:2021-04-08
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Headache, Visual impairment

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: None, other than tea (ginger, cinnamon, black tea)
Current Illness: None
Preexisting Conditions: None
Allergies: None known known
Diagnostic Lab Data: None. Does not have insurance or care provider. Will look for care that is free.
CDC 'Split Type':

Write-up: Severe headache x 5 days affecting ability to see and complete daily activities


Changed on 5/14/2021

VAERS ID: 1248849 Before After
VAERS Form:2
Age:37.0
Sex:Male
Location:Michigan
Vaccinated:2021-04-08
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Headache, Visual impairment

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: None, other than tea (ginger, cinnamon, black tea)
Current Illness: None
Preexisting Conditions: None
Allergies: None known known
Diagnostic Lab Data: None. Does not have insurance or care provider. Will look for care that is free.
CDC 'Split Type':

Write-up: Severe headache x 5 days affecting ability to see and complete daily activities

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1248849&WAYBACKHISTORY=ON


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