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This is VAERS ID 1089709

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1089709
VAERS Form:2
Age:64.0
Sex:Male
Location:Arizona
Vaccinated:2021-03-10
Onset:2021-03-10
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dyspnoea, Pallor, Syncope, Peripheral swelling, Contusion, Eye movement disorder

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: Lisinopril
Current Illness: Nothing
Preexisting Conditions: High Blood Pressure
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After receiving the vaccine with in minutes the patients left arm began to swell and bruise. He began to become pale and his eyes rolled back into his head and passed out. He woke up a min later and had SOB. Very pale and almost threw up. Paramedics and Firefighters were called. The eveulated the patients and gave him a liter of sodium choride. His Heart Rate was in the 30''s. After several min and a liter of fluid, patient was alert. Once stable he was transported to Hospital.


Changed on 5/7/2021

VAERS ID: 1089709 Before After
VAERS Form:2
Age:64.0
Sex:Male
Location:Arizona
Vaccinated:2021-03-10
Onset:2021-03-10
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dyspnoea, Pallor, Syncope, Peripheral swelling, Contusion, Eye movement disorder

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: Lisinopril
Current Illness: Nothing
Preexisting Conditions: High Blood Pressure
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After receiving the vaccine with in minutes the patients left arm began to swell and bruise. He began to become pale and his eyes rolled back into his head and passed out. He woke up a min later and had SOB. Very pale and almost threw up. Paramedics and Firefighters were called. The eveulated the patients and gave him a liter of sodium choride. His Heart Rate was in the 30''s. After several min and a liter of fluid, patient was alert. Once stable he was transported to Hospital.


Changed on 5/14/2021

VAERS ID: 1089709 Before After
VAERS Form:2
Age:64.0
Sex:Male
Location:Arizona
Vaccinated:2021-03-10
Onset:2021-03-10
Submitted:0000-00-00
Entered:2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dyspnoea, Pallor, Syncope, Peripheral swelling, Contusion, Eye movement disorder

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: Lisinopril
Current Illness: Nothing
Preexisting Conditions: High Blood Pressure
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: After receiving the vaccine with in minutes the patients left arm began to swell and bruise. He began to become pale and his eyes rolled back into his head and passed out. He woke up a min later and had SOB. Very pale and almost threw up. Paramedics and Firefighters were called. The eveulated the patients and gave him a liter of sodium choride. His Heart Rate was in the 30''s. After several min and a liter of fluid, patient was alert. Once stable he was transported to Hospital.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1089709&WAYBACKHISTORY=ON


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