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This is VAERS ID 1260995

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1260995
VAERS Form:2
Age:23.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-04-10
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Public      Purchased by: ??
Symptoms: Abdominal pain upper, Chest pain, Headache, Neuralgia

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide Oxiracitam Alpha-GPC
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Food triggered attacks with symptoms of: stomach pain, headache, nerve pain, chest pain


Changed on 5/7/2021

VAERS ID: 1260995 Before After
VAERS Form:2
Age:23.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-04-10
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Public      Purchased by: ??
Symptoms: Abdominal pain upper, Chest pain, Headache, Neuralgia

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide Oxiracitam Alpha-GPC
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Food triggered attacks with symptoms of: stomach pain, headache, nerve pain, chest pain


Changed on 5/14/2021

VAERS ID: 1260995 Before After
VAERS Form:2
Age:23.0
Sex:Male
Location:Wisconsin
Vaccinated:2021-04-10
Onset:2021-04-19
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Public      Purchased by: ??
Symptoms: Abdominal pain upper, Chest pain, Headache, Neuralgia

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hydrochlorothiazide Oxiracitam Alpha-GPC
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Food triggered attacks with symptoms of: stomach pain, headache, nerve pain, chest pain

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