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This is VAERS ID 1694094

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1694094
VAERS Form:2
Age:47.0
Sex:Male
Location:Maryland
Vaccinated:2021-09-12
Onset:2021-09-12
Submitted:0000-00-00
Entered:2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / -

Administered by: Pharmacy      Purchased by: ??
Symptoms: Influenza, Influenza like illness, Injection site pain, Pyrexia, Impaired work ability, Immediate post-injection reaction

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: Tadalafil, Krill Oil, D2, Zinc
Current Illness: None.
Preexisting Conditions: BPH
Allergies: Cafergot
Diagnostic Lab Data: None.
CDC 'Split Type':

Write-up: Severe Site Pain, Soreness in Full Deltoid was immediate. Following that about 3 hours later flu (covid) like symptoms set in. Fever of 102 as of 9/13/21 @ 0600. Fever persisted throughout day. stayed in bed unable to work. Felt like a moderate 24/36 hour flu.

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