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This is VAERS ID 1470452

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1470452
VAERS Form:2
Age:41.0
Sex:Male
Location:Michigan
Vaccinated:2021-07-03
Onset:2021-07-03
Submitted:0000-00-00
Entered:2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820096 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Extra dose administered, 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt had 1st Pfizer dose 4/27/2021 then 2nd Pfizer dose 5/18/2021 at the Pharmacy , then presented to us on 7/3/2021 requesting the J & J immunization. Pt stated NO to receiving any previous Covid-19 vaccines. We were unable to access medical record at that moment so immunized customer believing they had honestly answered the questions pertaining to previous immunizations. Went to add this immunization into the medical record and found the previous immunizations.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1470452&WAYBACKHISTORY=ON


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