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This is VAERS ID 1257459

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1257459
VAERS Form:2
Age:69.0
Sex:Female
Location:Unknown
Vaccinated:2021-04-12
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Incorrect dose administered

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Was giving injection in left deltoid and syringe came off and leaked some down arm . Sticker was close to needle and safety guard. Part of the dose leaked out during the injection. Patient received a partial dose of vaccine.


Changed on 5/7/2021

VAERS ID: 1257459 Before After
VAERS Form:2
Age:69.0
Sex:Female
Location:Unknown
Vaccinated:2021-04-12
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Incorrect dose administered

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Was giving injection in left deltoid and syringe came off and leaked some down arm . Sticker was close to needle and safety guard. Part of the dose leaked out during the injection. Patient received a partial dose of vaccine.


Changed on 5/14/2021

VAERS ID: 1257459 Before After
VAERS Form:2
Age:69.0
Sex:Female
Location:Unknown
Vaccinated:2021-04-12
Onset:2021-04-12
Submitted:0000-00-00
Entered:2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Incorrect dose administered

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Was giving injection in left deltoid and syringe came off and leaked some down arm . Sticker was close to needle and safety guard. Part of the dose leaked out during the injection. Patient received a partial dose of vaccine.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1257459&WAYBACKHISTORY=ON


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