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This is VAERS ID 1091905

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1091905
VAERS Form:2
Age:58.0
Sex:Female
Location:Kansas
Vaccinated:2021-03-11
Onset:2021-03-11
Submitted:0000-00-00
Entered:2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Anxiety, Dizziness, Electrocardiogram normal, Paraesthesia

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: Furosemide, Lopressor, Topamax, Multivitamin, Vitamin E, Alphagan opth drops, Lumigan opth drops, Lutein, Stark Pharmacy Hormone replacement specialty compound, Trelegy inhaler
Current Illness: Ischemia, anxiety
Preexisting Conditions: unknown
Allergies: Penicillin
Diagnostic Lab Data: Pulse 120, Blood pressure 170/110, EKG - normal
CDC 'Split Type':

Write-up: Heart rate 120 bpm, Blood pressure 170/110, lightheaded, feeling faint, tingling, anxiety


Changed on 5/7/2021

VAERS ID: 1091905 Before After
VAERS Form:2
Age:58.0
Sex:Female
Location:Kansas
Vaccinated:2021-03-11
Onset:2021-03-11
Submitted:0000-00-00
Entered:2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Anxiety, Dizziness, Electrocardiogram normal, Paraesthesia

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: Furosemide, Lopressor, Topamax, Multivitamin, Vitamin E, Alphagan opth drops, Lumigan opth drops, Lutein, Stark Pharmacy Hormone replacement specialty compound, Trelegy inhaler
Current Illness: Ischemia, anxiety
Preexisting Conditions: unknown
Allergies: Penicillin Penicillin
Diagnostic Lab Data: Pulse 120, Blood pressure 170/110, EKG - normal
CDC 'Split Type':

Write-up: Heart rate 120 bpm, Blood pressure 170/110, lightheaded, feeling faint, tingling, anxiety


Changed on 5/14/2021

VAERS ID: 1091905 Before After
VAERS Form:2
Age:58.0
Sex:Female
Location:Kansas
Vaccinated:2021-03-11
Onset:2021-03-11
Submitted:0000-00-00
Entered:2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Anxiety, Dizziness, Electrocardiogram normal, Paraesthesia

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: Furosemide, Lopressor, Topamax, Multivitamin, Vitamin E, Alphagan opth drops, Lumigan opth drops, Lutein, Stark Pharmacy Hormone replacement specialty compound, Trelegy inhaler
Current Illness: Ischemia, anxiety
Preexisting Conditions: unknown
Allergies: Penicillin Penicillin
Diagnostic Lab Data: Pulse 120, Blood pressure 170/110, EKG - normal
CDC 'Split Type':

Write-up: Heart rate 120 bpm, Blood pressure 170/110, lightheaded, feeling faint, tingling, anxiety

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1091905&WAYBACKHISTORY=ON


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