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This is VAERS ID 1368222

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1368222
VAERS Form:2
Age:38.0
Sex:Male
Location:Illinois
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 / 2 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Interchange of vaccine products

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: 1. Atorvastatin 2. Citalopram 3. Fenofibrate 4. Novolog 5. Omeprazole
Current Illness: n/a
Preexisting Conditions: 1. Type 2 Diabetes 2. Hyperlipidemia 3. Male erectile dysfunction 4. Anxiety 5. Depression 6. Acid Reflux
Allergies: NKDA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient came in for 2nd dose of Moderna vaccine and received Janssen instead.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1368222&WAYBACKHISTORY=ON


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