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This is VAERS ID 1697164

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1697164
VAERS Form:2
Age:45.0
Sex:Female
Location:California
Vaccinated:2021-09-08
Onset:2021-09-08
Submitted:0000-00-00
Entered:2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK RA / SYR

Administered by: Other      Purchased by: ??
Symptoms: Mononucleosis heterophile test negative, Laboratory test, Streptococcus test negative, Mouth swelling, Pharyngeal swelling, SARS-CoV-2 test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Hormone medication
Current Illness: None
Preexisting Conditions: None
Allergies: Sulfa iodine shellfish. Percocet Bactrim
Diagnostic Lab Data: Phone appointment on 9-9 with primary care and emergency room on 9-10. Tested for covid. Strep throat and mononucleosis all negative other labs were taken as well.
CDC 'Split Type':

Write-up: Swelling In mouth and throat

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