National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1133281

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1133281
VAERS Form:2
Age:57.0
Sex:Female
Location:Maine
Vaccinated:2021-03-25
Onset:2021-03-25
Submitted:0000-00-00
Entered:2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 4 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Anxiety, Tachypnoea, Immediate post-injection reaction

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: Atenolol, Losartan, Valium, Zyrtec, acetazolamide, Baclofen
Current Illness: Mast cell activation
Preexisting Conditions: Mast cell activation, SVT, dystonia,
Allergies: Compazine
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: History of mast cell activation and patient stated she "usually has reactions to everything." Patient experienced tachypnea and anxiety immediately following administration of dose of vaccine. SxS persisted for approximately 45 minutes. EMS was called to the scene to evaluate patient. symptoms decreased after 45 minutes and patient stated she did not want to go to the hospital. Reference EMS Incident for full PCR. Advised patient to contact her primary care physician for follow up.


Changed on 5/7/2021

VAERS ID: 1133281 Before After
VAERS Form:2
Age:57.0
Sex:Female
Location:Maine
Vaccinated:2021-03-25
Onset:2021-03-25
Submitted:0000-00-00
Entered:2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 4 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Anxiety, Tachypnoea, Immediate post-injection reaction

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: Atenolol, Losartan, Valium, Zyrtec, acetazolamide, Baclofen
Current Illness: Mast cell activation
Preexisting Conditions: Mast cell activation, SVT, dystonia,
Allergies: Compazine Compazine
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: History of mast cell activation and patient stated she "usually has reactions to everything." Patient experienced tachypnea and anxiety immediately following administration of dose of vaccine. SxS persisted for approximately 45 minutes. EMS was called to the scene to evaluate patient. symptoms decreased after 45 minutes and patient stated she did not want to go to the hospital. Reference EMS Incident for full PCR. Advised patient to contact her primary care physician for follow up.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1133281&WAYBACKHISTORY=ON


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