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This is VAERS ID 1371669

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371669
VAERS Form:2
Age:33.0
Sex:Male
Location:Indiana
Vaccinated:2021-06-01
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Interchange of vaccine products, Inappropriate schedule of product administration

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: Pt had received a dose of Moderna on 4/9/2021. Pt is incarcerated in Jail. Unable to check accuracy of information while doing jail clinic. Received a dose of J&J while at jail clinic.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1371669&WAYBACKHISTORY=ON


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