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This is VAERS ID 1307963

History of Changes from the VAERS Wayback Machine

First Appeared on 5/14/2021

VAERS ID: 1307963
VAERS Form:2
Age:31.0
Sex:Female
Location:Illinois
Vaccinated:2021-05-01
Onset:2021-05-02
Submitted:0000-00-00
Entered:2021-05-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Injection site induration, Injection site mass, Injection site pain

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: unknown
Current Illness: None
Preexisting Conditions: None
Allergies: NKDA
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient has a quarter sized lump that is firm and has pain to the touch at the injection site 11 days after injection.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1307963&WAYBACKHISTORY=ON


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