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VAERS ID: 1171216

AGE: 16| SEX: F|State: NC

Description

none. The patient attested that she was 18 years of age.

Symptoms

Unevaluable event

Vaccines

VAX DATE: 31 March 2021 | ONSET DATE: 31 March 2021 | DAYS TO ONSET: 0
Vaccine TypeManufacturerVaccine NameDoseRouteSiteLot
  • COVID19
  • JANSSEN
  • COVID19 (COVID19 (JANSSEN))
  • 1
  • IM
  • LA
  • 043A21A

RECVDATE:05 April 2021
CAGE_YR:16
CAGE_MO:
RPT_DATE:
DIED:
DATEDIED:
L_THREAT:
ER_VISIT:
HOSPITAL:
HOSPDAYS:
X_STAY:
DISABLE:
RECOVD:U
LAB_DATA:
V_ADMINBY:SCH
OTHER_MEDS:
CUR_ILL:
HISTORY:
PRIOR_VAX:
SPLTTYPE:
FORM_VERS:2
TODAYS_DATE:05 April 2021
BIRTH_DEFECT:
OFC_VISIT:
ER_ED_VISIT:
ALLERGIES:
V_FUNDBY:
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