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This is VAERS ID 1700334

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1700334
VAERS Form:2
Age:65.0
Sex:Male
Location:Unknown
Vaccinated:2021-03-12
Onset:2021-09-12
Submitted:0000-00-00
Entered:2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Cough, Oxygen saturation decreased, Pyrexia, COVID-19

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)? Yes
Hospitalized? Yes, days:     Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: HTN, Atherosclerosis of bilat legs, meningioma of brain
Allergies: Lisinopril (swelling), Choline and Magnesium salicylate (swelling of face)
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt acquired covid-19 several months after administration of vaccine that requires hospitalization. Symptoms include sever, cough, decreased O2 saturation requiring supplemental oxygen administration.

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