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This is VAERS ID 1679012

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/10/2021

VAERS ID: 1679012
VAERS Form:2
Age:83.0
Sex:Male
Location:Kentucky
Vaccinated:2021-03-05
Onset:2021-09-03
Submitted:0000-00-00
Entered:2021-09-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: COVID-19, SARS-CoV-2 test positive

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? Yes, days: 5     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt received vaccine- pt is hospitalized with covid +, on nasal cannula

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