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This is VAERS ID 1367872

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1367872
VAERS Form:2
Age:46.0
Sex:Female
Location:Indiana
Vaccinated:2021-06-01
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / SYR

Administered by: Unknown      Purchased by: ??
Symptoms: Chills, Headache, Hypoaesthesia, Pain, Pain in extremity, Pyrexia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: Olmesartan and Contrave
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: 104.5 fever, severe headache, left leg and left arm pain and numbness, body aches, chills

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