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This is VAERS ID 1255652

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1255652
VAERS Form:2
Age:67.0
Sex:Male
Location:Florida
Vaccinated:2021-04-11
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Fatigue, Headache, Pain

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: Nexium, Centrum Silver (vitamin) Vitamin B12, Low Dose Asprin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Headache (4 days) , Body Aches (5 days), Fatigue (8 days)


Changed on 5/7/2021

VAERS ID: 1255652 Before After
VAERS Form:2
Age:67.0
Sex:Male
Location:Florida
Vaccinated:2021-04-11
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Fatigue, Headache, Pain

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: Nexium, Centrum Silver (vitamin) Vitamin B12, Low Dose Asprin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Headache (4 days) , Body Aches (5 days), Fatigue (8 days)


Changed on 5/14/2021

VAERS ID: 1255652 Before After
VAERS Form:2
Age:67.0
Sex:Male
Location:Florida
Vaccinated:2021-04-11
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Fatigue, Headache, Pain

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: Nexium, Centrum Silver (vitamin) Vitamin B12, Low Dose Asprin
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Headache (4 days) , Body Aches (5 days), Fatigue (8 days)

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1255652&WAYBACKHISTORY=ON


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