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This is VAERS ID 1330963

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1330963
VAERS Form:2
Age:39.0
Sex:Male
Location:Unknown
Vaccinated:2021-05-19
Onset:2021-05-19
Submitted:0000-00-00
Entered:2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 UN / IM

Administered by: Unknown      Purchased by: ??
Symptoms: No adverse event, Interchange of vaccine products

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:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Client received 1st dose of Pfizer on 04/28/2021. Client went through J&J vaccine line and verified with staff that they were receiving J&J vaccine. Client then received J&J vaccine, was observed for 30 minutes. No adverse reaction.

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