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This is VAERS ID 1269147

History of Changes from the VAERS Wayback Machine

First Appeared on 4/30/2021

VAERS ID: 1269147
VAERS Form:2
Age:
Sex:Unknown
Location:Minnesota
Vaccinated:0000-00-00
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: SARS-CoV-2 test, Suspected COVID-19

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: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210421; Test Name: COVID-19 antigen test; Result Unstructured Data: Positive; Test Date: 20210422; Test Name: COVID-19 antigen test; Result Unstructured Data: Positive
CDC 'Split Type': USJNJFOC20210446463

Write-up: SUSPECTED COVID-19 INFECTION; This spontaneous report received from a health care professional concerned a patient of unspecified age and sex. The patient''s weight, height, and medical history were not reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 12-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 21-APR-2021, the subject experienced suspected covid-19 infection. Laboratory data included: COVID-19 antigen test (NR: not provided) Positive. On 22-APR-2021, Laboratory data included: COVID-19 antigen test (NR: not provided) Positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of suspected covid-19 infection was not reported. This report was non-serious.; Sender''s Comments: V0 Medical assessment comment not required as per standard procedure as the case was assessed as non-serious.


Changed on 5/7/2021

VAERS ID: 1269147 Before After
VAERS Form:2
Age:
Sex:Unknown
Location:Minnesota
Vaccinated:0000-00-00
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: SARS-CoV-2 test, Suspected COVID-19

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: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210421; Test Name: COVID-19 antigen test; Result Unstructured Data: Positive; Test Date: 20210422; Test Name: COVID-19 antigen test; Result Unstructured Data: Positive
CDC 'Split Type': USJNJFOC20210446463

Write-up: SUSPECTED COVID-19 INFECTION; This spontaneous report received from a health care professional concerned a patient of unspecified age and sex. The patient''s weight, height, and medical history were not reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 12-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 21-APR-2021, the subject experienced suspected covid-19 infection. Laboratory data included: COVID-19 antigen test (NR: not provided) Positive. On 22-APR-2021, Laboratory data included: COVID-19 antigen test (NR: not provided) Positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of suspected covid-19 infection was not reported. This report was non-serious.; Sender''s Comments: V0 Medical assessment comment not required as per standard procedure as the case was assessed as non-serious.


Changed on 5/14/2021

VAERS ID: 1269147 Before After
VAERS Form:2
Age:
Sex:Unknown
Location:Minnesota
Vaccinated:0000-00-00
Onset:2021-04-21
Submitted:0000-00-00
Entered:2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: SARS-CoV-2 test, Suspected COVID-19

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: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210421; Test Name: COVID-19 antigen test; Result Unstructured Data: Positive; Test Date: 20210422; Test Name: COVID-19 antigen test; Result Unstructured Data: Positive
CDC 'Split Type': USJNJFOC20210446463

Write-up: SUSPECTED COVID-19 INFECTION; This spontaneous report received from a health care professional concerned a patient of unspecified age and sex. The patient''s weight, height, and medical history were not reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 12-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 21-APR-2021, the subject experienced suspected covid-19 infection. Laboratory data included: COVID-19 antigen test (NR: not provided) Positive. On 22-APR-2021, Laboratory data included: COVID-19 antigen test (NR: not provided) Positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of suspected covid-19 infection was not reported. This report was non-serious.; Sender''s Comments: V0 Medical assessment comment not required as per standard procedure as the case was assessed as non-serious.

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