National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1135899

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1135899
VAERS Form:2
Age:19.0
Sex:Male
Location:New York
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 1808978 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dizziness, Dyspnoea, Hypoaesthesia, 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: None known
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: none known
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: 1432hr Pt fell to the ground c/o shortness of breath & dizziness. Dose of J+J vaccine given about 15 minutes prior. B/P 70/50 HR 84 SPO2 100% on R.A., Lungs clear bilateral. Pt complained of tingling in both hands & feet. Pt refused epi but agreed to Benadryl 50MG po Liquid. Benadryl Administered at 1435hrs no improvement, pt feeling more short of breath & Numbness in Lt arm, 1 dose of epi administered at 1440. Pt had no improvement, pt complained of numbness now in right arm. At 1445 a 2nd epi pen was administered. 1447 pt stated he was feeling better. VS taken BP 100/60 R.24 HR 80 SPO2 97% RA. Lungs Clear bilateral. EMS arrived @1448. Pt stable and was transported to the hospital.


Changed on 5/7/2021

VAERS ID: 1135899 Before After
VAERS Form:2
Age:19.0
Sex:Male
Location:New York
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 1808978 / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dizziness, Dyspnoea, Hypoaesthesia, 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: None known
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: none known known
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: 1432hr Pt fell to the ground c/o shortness of breath & dizziness. Dose of J+J vaccine given about 15 minutes prior. B/P 70/50 HR 84 SPO2 100% on R.A., Lungs clear bilateral. Pt complained of tingling in both hands & feet. Pt refused epi but agreed to Benadryl 50MG po Liquid. Benadryl Administered at 1435hrs no improvement, pt feeling more short of breath & Numbness in Lt arm, 1 dose of epi administered at 1440. Pt had no improvement, pt complained of numbness now in right arm. At 1445 a 2nd epi pen was administered. 1447 pt stated he was feeling better. VS taken BP 100/60 R.24 HR 80 SPO2 97% RA. Lungs Clear bilateral. EMS arrived @1448. Pt stable and was transported to the hospital.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1135899&WAYBACKHISTORY=ON


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