National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1090746

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1090746
VAERS Form:2
Age:27.0
Sex:Female
Location:Pennsylvania
Vaccinated:2021-03-10
Onset:2021-03-10
Submitted:0000-00-00
Entered:2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Anxiety, Confusional state, Dizziness, Loss of consciousness, Muscular weakness, Nausea, Vomiting

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: Patient experiences syncope, n/v, and anxiousness during vaccine administration and while phlebotomy is being performed.
Other Medications: Ativan and also unknown anxiety medication.
Current Illness: Anxiety
Preexisting Conditions: Anxiety
Allergies: None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 3/10/2021 at approximately 2035, a female patient notified vaccine observation staff that she was feeling light headed, queasy and anxious. As staff began to assess the patient she began to pass out loosing consciousness. Staff were able to hold patient before any falls and lower her to the floor. The paramedic on scene began her emergency assessment of the patient. Staff paramedic was able to arouse the patient with a sternal rub. The patient was not fully aware of the event that had occurred. The paramedic place the patient on oxygen via nasal cannula. The patient?s level of consciousness began to improve. The patient stated she has a history of syncopal episode after any immunizations. The patient also relayed that she has a history of anxiety and is complaint with her medication. After secondary assessment of the patient, it was noted that the patient had an extended recovery time from the sycopal episode. She was unable to stand on her own and she still felt nauseous after vomiting. The staff at the clinic notified county EMS at 2055 and care of the patient was transferred.


Changed on 5/7/2021

VAERS ID: 1090746 Before After
VAERS Form:2
Age:27.0
Sex:Female
Location:Pennsylvania
Vaccinated:2021-03-10
Onset:2021-03-10
Submitted:0000-00-00
Entered:2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Anxiety, Confusional state, Dizziness, Loss of consciousness, Muscular weakness, Nausea, Vomiting

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: Patient experiences syncope, n/v, and anxiousness during vaccine administration and while phlebotomy is being performed.
Other Medications: Ativan and also unknown anxiety medication.
Current Illness: Anxiety
Preexisting Conditions: Anxiety
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 3/10/2021 at approximately 2035, a female patient notified vaccine observation staff that she was feeling light headed, queasy and anxious. As staff began to assess the patient she began to pass out loosing consciousness. Staff were able to hold patient before any falls and lower her to the floor. The paramedic on scene began her emergency assessment of the patient. Staff paramedic was able to arouse the patient with a sternal rub. The patient was not fully aware of the event that had occurred. The paramedic place the patient on oxygen via nasal cannula. The patient?s level of consciousness began to improve. The patient stated she has a history of syncopal episode after any immunizations. The patient also relayed that she has a history of anxiety and is complaint with her medication. After secondary assessment of the patient, it was noted that the patient had an extended recovery time from the sycopal episode. She was unable to stand on her own and she still felt nauseous after vomiting. The staff at the clinic notified county EMS at 2055 and care of the patient was transferred.


Changed on 5/14/2021

VAERS ID: 1090746 Before After
VAERS Form:2
Age:27.0
Sex:Female
Location:Pennsylvania
Vaccinated:2021-03-10
Onset:2021-03-10
Submitted:0000-00-00
Entered:2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Anxiety, Confusional state, Dizziness, Loss of consciousness, Muscular weakness, Nausea, Vomiting

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: Patient experiences syncope, n/v, and anxiousness during vaccine administration and while phlebotomy is being performed.
Other Medications: Ativan and also unknown anxiety medication.
Current Illness: Anxiety
Preexisting Conditions: Anxiety
Allergies: None None
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: On 3/10/2021 at approximately 2035, a female patient notified vaccine observation staff that she was feeling light headed, queasy and anxious. As staff began to assess the patient she began to pass out loosing consciousness. Staff were able to hold patient before any falls and lower her to the floor. The paramedic on scene began her emergency assessment of the patient. Staff paramedic was able to arouse the patient with a sternal rub. The patient was not fully aware of the event that had occurred. The paramedic place the patient on oxygen via nasal cannula. The patient?s level of consciousness began to improve. The patient stated she has a history of syncopal episode after any immunizations. The patient also relayed that she has a history of anxiety and is complaint with her medication. After secondary assessment of the patient, it was noted that the patient had an extended recovery time from the sycopal episode. She was unable to stand on her own and she still felt nauseous after vomiting. The staff at the clinic notified county EMS at 2055 and care of the patient was transferred.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1090746&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166