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This is VAERS ID 1084058

History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1084058
VAERS Form:2
Age:36.0
Sex:Female
Location:Connecticut
Vaccinated:2021-03-06
Onset:2021-03-06
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Dyspnoea, Fall, Post vaccination syndrome, Syncope, Vomiting, Tonic clonic movements

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? No
Previous Vaccinations:
Other Medications: Insulin
Current Illness:
Preexisting Conditions: Diabetes
Allergies: NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Post vaccination feeling of breath doom, walking to door to get fresh air. Syncope, fell to floor. No head injury. Post vaccination syncope, brief generalized tonic-clonic movement followed by emesis. Blood glucose 114, BP 120/80, HR90, O2 Sat 96%.


Changed on 5/7/2021

VAERS ID: 1084058 Before After
VAERS Form:2
Age:36.0
Sex:Female
Location:Connecticut
Vaccinated:2021-03-06
Onset:2021-03-06
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Dyspnoea, Fall, Post vaccination syndrome, Syncope, Vomiting, Tonic clonic movements

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? No
Previous Vaccinations:
Other Medications: Insulin
Current Illness:
Preexisting Conditions: Diabetes
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Post vaccination feeling of breath doom, walking to door to get fresh air. Syncope, fell to floor. No head injury. Post vaccination syncope, brief generalized tonic-clonic movement followed by emesis. Blood glucose 114, BP 120/80, HR90, O2 Sat 96%.


Changed on 5/14/2021

VAERS ID: 1084058 Before After
VAERS Form:2
Age:36.0
Sex:Female
Location:Connecticut
Vaccinated:2021-03-06
Onset:2021-03-06
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Dyspnoea, Fall, Post vaccination syndrome, Syncope, Vomiting, Tonic clonic movements

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? No
Previous Vaccinations:
Other Medications: Insulin
Current Illness:
Preexisting Conditions: Diabetes
Allergies: NKA NKA
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Post vaccination feeling of breath doom, walking to door to get fresh air. Syncope, fell to floor. No head injury. Post vaccination syncope, brief generalized tonic-clonic movement followed by emesis. Blood glucose 114, BP 120/80, HR90, O2 Sat 96%.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1084058&WAYBACKHISTORY=ON


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