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This is VAERS ID 1337279

History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1337279
VAERS Form:2
Age:31.0
Sex:Male
Location:Unknown
Vaccinated:2021-05-04
Onset:2021-05-04
Submitted:0000-00-00
Entered:2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / -

Administered by: Unknown      Purchased by: ??
Symptoms: Malaise

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: Patient stated " I don''t feel ok'' EMS came by patient side. Lead staff been aware of it. Patient vitals took by EMS BP 118/86, HR 61, O2 96. After 10 minutes lay flat and vitals taken. Patient Stated I feel good. Patient refused to go to the hospital.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1337279&WAYBACKHISTORY=ON


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