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This is VAERS ID 1130008

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1130008
VAERS Form:2
Age:22.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-03-22
Onset:2021-03-24
Submitted:0000-00-00
Entered:2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain, Dizziness, Hyperhidrosis, Nausea, Pallor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: 5 minutes following vaccination, patient became pale, sweaty, dizzy, and light headed. Vitals noted to be: Bp 88/60, P 100, R 16 no distress. Patient laid down on cot and given ice pack on neck. Patient also reported having nausea and abdominal cramps. Patient monitored for half hour. Color improved and Bp noted to improve to 110/66. Patient drove home by father.


Changed on 5/7/2021

VAERS ID: 1130008 Before After
VAERS Form:2
Age:22.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-03-22
Onset:2021-03-24
Submitted:0000-00-00
Entered:2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Abdominal pain, Dizziness, Hyperhidrosis, Nausea, Pallor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: 5 minutes following vaccination, patient became pale, sweaty, dizzy, and light headed. Vitals noted to be: Bp 88/60, P 100, R 16 no distress. Patient laid down on cot and given ice pack on neck. Patient also reported having nausea and abdominal cramps. Patient monitored for half hour. Color improved and Bp noted to improve to 110/66. Patient drove home by father.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1130008&WAYBACKHISTORY=ON


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