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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1083427



Case Details

VAERS ID: 1083427 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Connecticut  
Vaccinated:2021-03-06
Onset:2021-03-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Anxiety, Chills, Dizziness, Injection site pruritus
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Pantoprazole, PNV
Current Illness:
Preexisting Conditions: Asthma, GERD
Allergies: Magnevist dye
Diagnostic Lab Data:
CDC Split Type:

Write-up: Symptoms of feeling of doom and injection site itching after vaccine was received. No throat swelling, urticaria, hives, no progression of symptoms. Vital signs WNL -HR-90''s, BP-140/80, 02 Sat-99%. Persistent dizzy and chills. Transported for evaluation to ER.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1083427


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