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This is VAERS ID 1406701

History of Changes from the VAERS Wayback Machine

First Appeared on 6/18/2021

VAERS ID: 1406701
VAERS Form:2
Age:28.0
Sex:Male
Location:Virginia
Vaccinated:2021-06-03
Onset:2021-06-03
Submitted:0000-00-00
Entered:2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Extra dose administered, Interchange of vaccine products

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: When assessed, patient did not notify hospital that he had previously received a dose of Pfizer COVID vaccine. Patient stated that he wanted the COVID vaccine. On June 3rd patient received a dose of Janssen COVID vaccine. No adverse reactions noted during hospital stay.

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