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This is VAERS ID 1315169

History of Changes from the VAERS Wayback Machine

First Appeared on 5/14/2021

VAERS ID: 1315169
VAERS Form:2
Age:65.0
Sex:Male
Location:Washington
Vaccinated:2021-04-28
Onset:2021-05-02
Submitted:0000-00-00
Entered:2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204AZIA / UNK LA / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Unevaluable event

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: Blood thinkers. Very minor ones.
Current Illness: no
Preexisting Conditions: slight cold and minor heart attack 2009
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Facility

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1315169&WAYBACKHISTORY=ON


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