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This is VAERS ID 1085647

History of Changes from the VAERS Wayback Machine

First Appeared on 3/19/2021

VAERS ID: 1085647
VAERS Form:2
Age:57.0
Sex:Female
Location:New York
Vaccinated:2021-03-09
Onset:2021-03-09
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Anxiety, Asthenia, Dizziness, Electrocardiogram abnormal, Hypotension

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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Paramedic Reformat obtained vitals and noted patient to be hypotensive and anxious. She reports that she feels weak and dizzy. Repeat vitals and ecg done and pt still hypotensive. 12 lead shows irregularities. Pt recommended to be transported to hospital for eval. Pt agrees and IV access obtained. Saline bolus hung on patient. Pt care transferred for transport. Pt was transported to hospital.
CDC 'Split Type':

Write-up: Patient received vaccine at approximately 10:50 AM. She proceeded to the observation area where she began to feel light-headed. On-site EMS from was summoned. EMS placed the woman on their gurney and began assessment (vitals and EKG). A copy of the PCR has been requested, but may not be available.


Changed on 5/7/2021

VAERS ID: 1085647 Before After
VAERS Form:2
Age:57.0
Sex:Female
Location:New York
Vaccinated:2021-03-09
Onset:2021-03-09
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Anxiety, Asthenia, Dizziness, Electrocardiogram abnormal, Hypotension

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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown Unknown
Diagnostic Lab Data: Paramedic Reformat obtained vitals and noted patient to be hypotensive and anxious. She reports that she feels weak and dizzy. Repeat vitals and ecg done and pt still hypotensive. 12 lead shows irregularities. Pt recommended to be transported to hospital for eval. Pt agrees and IV access obtained. Saline bolus hung on patient. Pt care transferred for transport. Pt was transported to hospital.
CDC 'Split Type':

Write-up: Patient received vaccine at approximately 10:50 AM. She proceeded to the observation area where she began to feel light-headed. On-site EMS from was summoned. EMS placed the woman on their gurney and began assessment (vitals and EKG). A copy of the PCR has been requested, but may not be available.


Changed on 5/14/2021

VAERS ID: 1085647 Before After
VAERS Form:2
Age:57.0
Sex:Female
Location:New York
Vaccinated:2021-03-09
Onset:2021-03-09
Submitted:0000-00-00
Entered:2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Anxiety, Asthenia, Dizziness, Electrocardiogram abnormal, Hypotension

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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown Unknown
Diagnostic Lab Data: Paramedic Reformat obtained vitals and noted patient to be hypotensive and anxious. She reports that she feels weak and dizzy. Repeat vitals and ecg done and pt still hypotensive. 12 lead shows irregularities. Pt recommended to be transported to hospital for eval. Pt agrees and IV access obtained. Saline bolus hung on patient. Pt care transferred for transport. Pt was transported to hospital.
CDC 'Split Type':

Write-up: Patient received vaccine at approximately 10:50 AM. She proceeded to the observation area where she began to feel light-headed. On-site EMS from was summoned. EMS placed the woman on their gurney and began assessment (vitals and EKG). A copy of the PCR has been requested, but may not be available.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1085647&WAYBACKHISTORY=ON


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