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This is VAERS ID 1391822

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1391822
VAERS Form:2
Age:23.0
Sex:Female
Location:Illinois
Vaccinated:2021-06-03
Onset:2021-06-03
Submitted:0000-00-00
Entered:2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK AR / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Cough, Dyspnoea, Heart rate increased, Malaise, Pneumonia, Respiratory rate increased

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? Yes, days: 1     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amoxicillin for tooth
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Shellfish
Diagnostic Lab Data: Unknown - Care provided at Hospital, - Length of hospital stay unknown. Form requires number of days hospitalized. Indicated 1 in order to be able to submit the report.
CDC 'Split Type':

Write-up: Patient did not feel well after receiving vaccination. Indicated that she developed a cough, shortness of breath and increased respirations and pulse. She admitted to the hospital on 6/8/21 and was diagnosed with pneumonia.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1391822&WAYBACKHISTORY=ON


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