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This is VAERS ID 1136915

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1136915
VAERS Form:2
Age:57.0
Sex:Female
Location:Georgia
Vaccinated:2021-03-26
Onset:2021-03-26
Submitted:0000-00-00
Entered:2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Dyspnoea, Heart rate increased, Paraesthesia, Pruritus

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 reported
Current Illness: None Reported
Preexisting Conditions: None Reported
Allergies: IVP Dye; Shellfish
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Complaint of itching and tingling around neck, ears, and face. Felt as if had rapid heart rate and short of breath. Blood Pressure stable at 150/85 and 158/90 and Heartrate 66-80/min. O2 Sat 88% when EMS arrived. Epinephrine .5mg epinephrine administered and Benadryl 50 mg IM; O2 at 2 L NC. EMS called and transported to Medical Center. Stable at time of departure with EMS at 9:34. Reaction started within 15 minutes of receiving vaccine.


Changed on 5/7/2021

VAERS ID: 1136915 Before After
VAERS Form:2
Age:57.0
Sex:Female
Location:Georgia
Vaccinated:2021-03-26
Onset:2021-03-26
Submitted:0000-00-00
Entered:2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Dyspnoea, Heart rate increased, Paraesthesia, Pruritus

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 reported
Current Illness: None Reported
Preexisting Conditions: None Reported
Allergies: IVP Dye; Shellfish Shellfish
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Complaint of itching and tingling around neck, ears, and face. Felt as if had rapid heart rate and short of breath. Blood Pressure stable at 150/85 and 158/90 and Heartrate 66-80/min. O2 Sat 88% when EMS arrived. Epinephrine .5mg epinephrine administered and Benadryl 50 mg IM; O2 at 2 L NC. EMS called and transported to Medical Center. Stable at time of departure with EMS at 9:34. Reaction started within 15 minutes of receiving vaccine.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1136915&WAYBACKHISTORY=ON


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