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This is VAERS ID 1312039

History of Changes from the VAERS Wayback Machine

First Appeared on 5/14/2021

VAERS ID: 1312039
VAERS Form:2
Age:70.0
Sex:Female
Location:Vermont
Vaccinated:2021-04-30
Onset:2021-05-02
Submitted:0000-00-00
Entered:2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Chills, Fatigue, Memory impairment, Pyrexia, Urinary tract infection, Culture negative, Urine analysis abnormal

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: Vivelle, progesterone
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: urinalysis and culture, 05/05/2021
CDC 'Split Type':

Write-up: severe chills, fever, fatigue, urinary tract infection (no symptoms before 5/02, more memory problems than previous ( normal aging, not dementia).

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