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This is VAERS ID 1351027

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History of Changes from the VAERS Wayback Machine

First Appeared on 5/28/2021

VAERS ID: 1351027
VAERS Form:2
Age:85.0
Sex:Female
Location:Washington
Vaccinated:2021-05-22
Onset:2021-05-22
Submitted:0000-00-00
Entered:2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / UNK - / -

Administered by: Private      Purchased by: ??
Symptoms: Interchange of vaccine products, Pharyngeal swelling

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)? Yes
Hospitalized? No
Previous Vaccinations: Jan 15th 2021 Moderna Covid Vaccine 85 years old
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: swelling in throat, very similar to previous vaccination Patient received Moderna # 1 on Jan 15th had difficulty swallowing, tingling on tongue and jitters Patient was recommended by PCP who also consulted H to receive the Janssen Vaccine. Vaccine clinic spoke with ID specialist and looked at recommendation and decided to proceed with vaccinating patient

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