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This is VAERS ID 1083182

History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1083182
VAERS Form:2
Age:28.0
Sex:Female
Location:Georgia
Vaccinated:2021-03-08
Onset:2021-03-08
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 7+ LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient did not state any medication history
Current Illness: none
Preexisting Conditions: none
Allergies: NKA
Diagnostic Lab Data: monitored vitals in pharmacy until EMT arrived-3/8/2021
CDC 'Split Type':

Write-up: patient stated she was fine after vaccine, then after a few minutes she stated she felt dizzy. before pharmacist could get back around counter to patient, she fainted and slid out of her chair. patient was alert moments after landing on the floor. patient was laid out on floor and vitals monitored. once vitals returned to normal and patient felt better, she was given water and a banana. EMT arrived and evaluated patient. patient was taken to hospital per EMT suggestion. time frame: 17:26-17:52


Changed on 5/7/2021

VAERS ID: 1083182 Before After
VAERS Form:2
Age:28.0
Sex:Female
Location:Georgia
Vaccinated:2021-03-08
Onset:2021-03-08
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 7+ LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient did not state any medication history
Current Illness: none
Preexisting Conditions: none
Allergies: NKA NKA
Diagnostic Lab Data: monitored vitals in pharmacy until EMT arrived-3/8/2021
CDC 'Split Type':

Write-up: patient stated she was fine after vaccine, then after a few minutes she stated she felt dizzy. before pharmacist could get back around counter to patient, she fainted and slid out of her chair. patient was alert moments after landing on the floor. patient was laid out on floor and vitals monitored. once vitals returned to normal and patient felt better, she was given water and a banana. EMT arrived and evaluated patient. patient was taken to hospital per EMT suggestion. time frame: 17:26-17:52


Changed on 5/14/2021

VAERS ID: 1083182 Before After
VAERS Form:2
Age:28.0
Sex:Female
Location:Georgia
Vaccinated:2021-03-08
Onset:2021-03-08
Submitted:0000-00-00
Entered:2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 7+ LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Patient did not state any medication history
Current Illness: none
Preexisting Conditions: none
Allergies: NKA NKA
Diagnostic Lab Data: monitored vitals in pharmacy until EMT arrived-3/8/2021
CDC 'Split Type':

Write-up: patient stated she was fine after vaccine, then after a few minutes she stated she felt dizzy. before pharmacist could get back around counter to patient, she fainted and slid out of her chair. patient was alert moments after landing on the floor. patient was laid out on floor and vitals monitored. once vitals returned to normal and patient felt better, she was given water and a banana. EMT arrived and evaluated patient. patient was taken to hospital per EMT suggestion. time frame: 17:26-17:52

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1083182&WAYBACKHISTORY=ON


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