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This is VAERS ID 1090432

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1090432
VAERS Form:2
Age:34.0
Sex:Female
Location:Texas
Vaccinated:2021-03-09
Onset:2021-03-10
Submitted:0000-00-00
Entered:2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802072 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Anxiety, Asthenia, Dyskinesia, Flushing, Hyperhidrosis, Hypotonia, Nausea, Pallor, Panic attack, Syncope, Tremor, Unresponsive to stimuli, Urinary incontinence

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Nausea-Medium, Systemic: Shakiness-Mild, Systemic: Weakness-Medium, Additional Details: 1:19PM: Pt expressed anxiety, received vaccination, c/o of panic attack and sad down by the chair. 3 secs later, looked flaccid, unresponsive, discolorized, jerked breafly, bladder incontinent, loud sound, no difficulty breathing, no allergic reaction. RPH open airway, layed on side, head raised and called 911. Pt immediated had a deep breath and became responsive, alert/oriented x3. Ambulance, SaO2 97%.Pt later didn''t see the need to urgent care, husband insisted, transported out by ambulance.


Changed on 5/7/2021

VAERS ID: 1090432 Before After
VAERS Form:2
Age:34.0
Sex:Female
Location:Texas
Vaccinated:2021-03-09
Onset:2021-03-10
Submitted:0000-00-00
Entered:2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802072 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Anxiety, Asthenia, Dyskinesia, Flushing, Hyperhidrosis, Hypotonia, Nausea, Pallor, Panic attack, Syncope, Tremor, Unresponsive to stimuli, Urinary incontinence

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Nausea-Medium, Systemic: Shakiness-Mild, Systemic: Weakness-Medium, Additional Details: 1:19PM: Pt expressed anxiety, received vaccination, c/o of panic attack and sad down by the chair. 3 secs later, looked flaccid, unresponsive, discolorized, jerked breafly, bladder incontinent, loud sound, no difficulty breathing, no allergic reaction. RPH open airway, layed on side, head raised and called 911. Pt immediated had a deep breath and became responsive, alert/oriented x3. Ambulance, SaO2 97%.Pt later didn''t see the need to urgent care, husband insisted, transported out by ambulance.


Changed on 5/14/2021

VAERS ID: 1090432 Before After
VAERS Form:2
Age:34.0
Sex:Female
Location:Texas
Vaccinated:2021-03-09
Onset:2021-03-10
Submitted:0000-00-00
Entered:2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802072 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Anxiety, Asthenia, Dyskinesia, Flushing, Hyperhidrosis, Hypotonia, Nausea, Pallor, Panic attack, Syncope, Tremor, Unresponsive to stimuli, Urinary incontinence

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Fainting / Unresponsive-Severe, Systemic: Flushed / Sweating-Medium, Systemic: Nausea-Medium, Systemic: Shakiness-Mild, Systemic: Weakness-Medium, Additional Details: 1:19PM: Pt expressed anxiety, received vaccination, c/o of panic attack and sad down by the chair. 3 secs later, looked flaccid, unresponsive, discolorized, jerked breafly, bladder incontinent, loud sound, no difficulty breathing, no allergic reaction. RPH open airway, layed on side, head raised and called 911. Pt immediated had a deep breath and became responsive, alert/oriented x3. Ambulance, SaO2 97%.Pt later didn''t see the need to urgent care, husband insisted, transported out by ambulance.

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