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This is VAERS ID 1258372

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1258372
VAERS Form:2
Age:59.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Blood immunoglobulin G, Blood immunoglobulin M, Chest X-ray, Culture urine, Differential white blood cell count, Full blood count, Microtia, Pyrexia, Blood test, Parasite DNA test, Parasite blood test, SARS-CoV-2 test

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: Lipitor, Ropinirole, Clonazapem, Hydrochlorothiazide, Levothyroxine, Zyrtec, Folic Acid, B12, calcium, Vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: Kiwi Fruit, Avalox, Doxycycline, Erthromycin, Penicillan, Sulfides
Diagnostic Lab Data: 4/15: COVID Test 4/16: Initial visit to Urgent Care - prescribed Z-Pack 4/20: Second visit to Urgent Care: Chest X-Ray, Urine Culture, Blood work for , LYME IGG/IGM, BABESIA DNA, BABESIA MICROTI DNA, ANAPL PHAG DNA, CBC Differential, Parasites - Blood
CDC 'Split Type':

Write-up: Fever of 102.5 on 4/13, fever of 101.3 on 4/14, fever of 103.6 on 4/15.


Changed on 5/7/2021

VAERS ID: 1258372 Before After
VAERS Form:2
Age:59.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Blood immunoglobulin G, Blood immunoglobulin M, Chest X-ray, Culture urine, Differential white blood cell count, Full blood count, Microtia, Pyrexia, Blood test, Parasite DNA test, Parasite blood test, SARS-CoV-2 test

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: Lipitor, Ropinirole, Clonazapem, Hydrochlorothiazide, Levothyroxine, Zyrtec, Folic Acid, B12, calcium, Vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: Kiwi Fruit, Avalox, Doxycycline, Erthromycin, Penicillan, Sulfides Sulfides
Diagnostic Lab Data: 4/15: COVID Test 4/16: Initial visit to Urgent Care - prescribed Z-Pack 4/20: Second visit to Urgent Care: Chest X-Ray, Urine Culture, Blood work for , LYME IGG/IGM, BABESIA DNA, BABESIA MICROTI DNA, ANAPL PHAG DNA, CBC Differential, Parasites - Blood
CDC 'Split Type':

Write-up: Fever of 102.5 on 4/13, fever of 101.3 on 4/14, fever of 103.6 on 4/15.


Changed on 5/14/2021

VAERS ID: 1258372 Before After
VAERS Form:2
Age:59.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Blood immunoglobulin G, Blood immunoglobulin M, Chest X-ray, Culture urine, Differential white blood cell count, Full blood count, Microtia, Pyrexia, Blood test, Parasite DNA test, Parasite blood test, SARS-CoV-2 test

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: Lipitor, Ropinirole, Clonazapem, Hydrochlorothiazide, Levothyroxine, Zyrtec, Folic Acid, B12, calcium, Vitamin D
Current Illness: None
Preexisting Conditions: None
Allergies: Kiwi Fruit, Avalox, Doxycycline, Erthromycin, Penicillan, Sulfides Sulfides
Diagnostic Lab Data: 4/15: COVID Test 4/16: Initial visit to Urgent Care - prescribed Z-Pack 4/20: Second visit to Urgent Care: Chest X-Ray, Urine Culture, Blood work for , LYME IGG/IGM, BABESIA DNA, BABESIA MICROTI DNA, ANAPL PHAG DNA, CBC Differential, Parasites - Blood
CDC 'Split Type':

Write-up: Fever of 102.5 on 4/13, fever of 101.3 on 4/14, fever of 103.6 on 4/15.

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