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This is VAERS ID 1258926

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1258926
VAERS Form:2
Age:62.0
Sex:Male
Location:Michigan
Vaccinated:2021-03-16
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802070 / N/A - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Dyspnoea, COVID-19, SARS-CoV-2 test positive

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: covid test positive SARS-CoV-2 (COVID-19), Micro Detected 4/24/2021
CDC 'Split Type':

Write-up: covid symptoms SOB $g 14 days after vaccine ( 4/21/21) covid test positive


Changed on 5/7/2021

VAERS ID: 1258926 Before After
VAERS Form:2
Age:62.0
Sex:Male
Location:Michigan
Vaccinated:2021-03-16
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802070 / N/A - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Dyspnoea, COVID-19, SARS-CoV-2 test positive

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: covid test positive SARS-CoV-2 (COVID-19), Micro Detected 4/24/2021
CDC 'Split Type':

Write-up: covid symptoms SOB $g 14 days after vaccine ( 4/21/21) covid test positive


Changed on 5/14/2021

VAERS ID: 1258926 Before After
VAERS Form:2
Age:62.0
Sex:Male
Location:Michigan
Vaccinated:2021-03-16
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802070 / N/A - / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Dyspnoea, COVID-19, SARS-CoV-2 test positive

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: covid test positive SARS-CoV-2 (COVID-19), Micro Detected 4/24/2021
CDC 'Split Type':

Write-up: covid symptoms SOB $g 14 days after vaccine ( 4/21/21) covid test positive

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1258926&WAYBACKHISTORY=ON


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