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This is VAERS ID 1263096

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1263096
VAERS Form:2
Age:82.0
Sex:Male
Location:New York
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Confusional state, Decreased appetite

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: prior gastric cancer and colon cancer, HTN, DM, dementia
Allergies: NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: decreased appetite and confusion for 2 weeks since getting vaccine


Changed on 5/7/2021

VAERS ID: 1263096 Before After
VAERS Form:2
Age:82.0
Sex:Male
Location:New York
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Confusional state, Decreased appetite

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: prior gastric cancer and colon cancer, HTN, DM, dementia
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: decreased appetite and confusion for 2 weeks since getting vaccine


Changed on 5/14/2021

VAERS ID: 1263096 Before After
VAERS Form:2
Age:82.0
Sex:Male
Location:New York
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Confusional state, Decreased appetite

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? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: prior gastric cancer and colon cancer, HTN, DM, dementia
Allergies: NKDA NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: decreased appetite and confusion for 2 weeks since getting vaccine

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1263096&WAYBACKHISTORY=ON


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