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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1381909

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Case Details

VAERS ID: 1381909 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:2021-04-10
Onset:2021-06-01
   Days after vaccination:52
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

Administered by: School       Purchased by: ?
Symptoms: Herpes zoster
SMQs:, Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Amlodipine (5 mg) Carvedilol (3.125 mg) Rosvustatin (5 mg) Baby Aspirin
Current Illness: Heart disease, sleep apnea, hypertension
Preexisting Conditions: N/A
Allergies: None
Diagnostic Lab Data: Visual inspection
CDC Split Type:

Write-up: Shingles developed on my left lower back and torso approximately three month after receiving the Covid-19 vaccine.


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