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This is VAERS ID 1129904

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1129904
VAERS Form:2
Age:62.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-03-24
Onset:2021-03-24
Submitted:0000-00-00
Entered:2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / UNK RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Dizziness, Tremor, Visual impairment

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: albuterol (PROVENTIL HFA;VENTOLIN HFA;PROAIR HFA) inhaler ALPRAZolam (XANAX) 0.5 MG tablet amLODIPine (NORVASC) 5 MG tablet atorvastatin (LIPITOR) 20 MG tablet busPIRone (BUSPAR) 5 MG tablet diphenhydrAMINE (BENADRYL) 25 mg capsul
Current Illness: none
Preexisting Conditions: Essential hypertension, benign (*) Sleep apnea Migraine headache (*) Asthma (*) Pure hyperglyceridemia (*) Generalized anxiety disorder (*) Controlled type 2 diabetes mellitus with renal manifestation (*) Hyperlipidemia Proteinuria Controlled type 2 diabetes mellitus without complication (*) MDD (major depressive disorder), recurrent severe, without psychosis (*) Panic disorder without agoraphobia (*)
Allergies: CodeineHives Contrast [Iodinated Contrast Media]Hives Darvon [Propoxyphene]Hives ErythromycinNausea And Vomiting Hydrocodone PiroxicamOther (See Comments) Garamycin [Gentamicin]Rash Monistat 1 [Tioconazole]Rash PropranololRash Sulfa (Sulfonamide Antibiotics)Rash
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient experienced lightheadedness, spots in vision, and shakiness approximately 30 mins after receiving the vaccine. Was monitored for 25 mins with no resolution in symptoms and was sent to the emergency room for additional evaluation.


Changed on 5/7/2021

VAERS ID: 1129904 Before After
VAERS Form:2
Age:62.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-03-24
Onset:2021-03-24
Submitted:0000-00-00
Entered:2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / UNK RA / IM

Administered by: Private      Purchased by: ??
Symptoms: Dizziness, Tremor, Visual impairment

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: albuterol (PROVENTIL HFA;VENTOLIN HFA;PROAIR HFA) inhaler ALPRAZolam (XANAX) 0.5 MG tablet amLODIPine (NORVASC) 5 MG tablet atorvastatin (LIPITOR) 20 MG tablet busPIRone (BUSPAR) 5 MG tablet diphenhydrAMINE (BENADRYL) 25 mg capsul
Current Illness: none
Preexisting Conditions: Essential hypertension, benign (*) Sleep apnea Migraine headache (*) Asthma (*) Pure hyperglyceridemia (*) Generalized anxiety disorder (*) Controlled type 2 diabetes mellitus with renal manifestation (*) Hyperlipidemia Proteinuria Controlled type 2 diabetes mellitus without complication (*) MDD (major depressive disorder), recurrent severe, without psychosis (*) Panic disorder without agoraphobia (*)
Allergies: CodeineHives Contrast [Iodinated Contrast Media]Hives Darvon [Propoxyphene]Hives ErythromycinNausea And Vomiting Hydrocodone PiroxicamOther (See Comments) Garamycin [Gentamicin]Rash Monistat 1 [Tioconazole]Rash PropranololRash Sulfa (Sulfonamide Antibiotics)Rash Antibiotics)Rash
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient experienced lightheadedness, spots in vision, and shakiness approximately 30 mins after receiving the vaccine. Was monitored for 25 mins with no resolution in symptoms and was sent to the emergency room for additional evaluation.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1129904&WAYBACKHISTORY=ON


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