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This is VAERS ID 1771636

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/15/2021

VAERS ID: 1771636
VAERS Form:2
Age:58.0
Sex:Male
Location:Florida
Vaccinated:2021-08-17
Onset:2021-10-01
Submitted:0000-00-00
Entered:2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Rash

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: plavxi, lipitor, ASA, metoprolol, metformin, famotidine
Current Illness: none
Preexisting Conditions: DM, MI with stents, HLD, HTN
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: rash, 10/2021. does not feel right since the vaccine

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