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This is VAERS ID 1091912

History of Changes from the VAERS Wayback Machine

First Appeared on 3/26/2021

VAERS ID: 1091912
VAERS Form:2
Age:56.0
Sex:Female
Location:Indiana
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 1805029 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Seizure, Unresponsive to stimuli

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: Sensitivity to epi
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was given the vaccine in her left arm. pt went unresponsive and began to have seizure like activity . Pt was in a chair and lowered to the floor with the assistance of the nurse on her right side. 911 was called. 02 at 2L was administered. pt then became responsive. EMTs arrived and transported pt to hospital.


Changed on 5/7/2021

VAERS ID: 1091912 Before After
VAERS Form:2
Age:56.0
Sex:Female
Location:Indiana
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 1805029 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Seizure, Unresponsive to stimuli

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: Sensitivity to epi epi
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was given the vaccine in her left arm. pt went unresponsive and began to have seizure like activity . Pt was in a chair and lowered to the floor with the assistance of the nurse on her right side. 911 was called. 02 at 2L was administered. pt then became responsive. EMTs arrived and transported pt to hospital.


Changed on 5/14/2021

VAERS ID: 1091912 Before After
VAERS Form:2
Age:56.0
Sex:Female
Location:Indiana
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 1805029 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Seizure, Unresponsive to stimuli

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: Sensitivity to epi epi
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt was given the vaccine in her left arm. pt went unresponsive and began to have seizure like activity . Pt was in a chair and lowered to the floor with the assistance of the nurse on her right side. 911 was called. 02 at 2L was administered. pt then became responsive. EMTs arrived and transported pt to hospital.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1091912&WAYBACKHISTORY=ON


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