National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1172613

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1172613
VAERS Form:2
Age:25.0
Sex:Female
Location:Michigan
Vaccinated:2021-04-06
Onset:2021-04-06
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Fall, Heart rate, Loss of consciousness, Cognitive disorder, Blood pressure measurement

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
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: 80/46 mmHg w/ 60bpm. Patient reports feeling "hot" and was visibly sweating. Skin was pale.
CDC 'Split Type':

Write-up: Patient reported feeling dizzy. Advised the patient to remain seated. Patient lost consciousness and fell to the ground. Sat patient upright and began screening for medical history. Cognition was low and speech was quiet. Measured blood pressure and pulse (80/46 mmHg pulse of 60bpm).


Changed on 5/7/2021

VAERS ID: 1172613 Before After
VAERS Form:2
Age:25.0
Sex:Female
Location:Michigan
Vaccinated:2021-04-06
Onset:2021-04-06
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Fall, Heart rate, Loss of consciousness, Cognitive disorder, Blood pressure measurement

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
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: 80/46 mmHg w/ 60bpm. Patient reports feeling "hot" and was visibly sweating. Skin was pale.
CDC 'Split Type':

Write-up: Patient reported feeling dizzy. Advised the patient to remain seated. Patient lost consciousness and fell to the ground. Sat patient upright and began screening for medical history. Cognition was low and speech was quiet. Measured blood pressure and pulse (80/46 mmHg pulse of 60bpm).


Changed on 5/14/2021

VAERS ID: 1172613 Before After
VAERS Form:2
Age:25.0
Sex:Female
Location:Michigan
Vaccinated:2021-04-06
Onset:2021-04-06
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Fall, Heart rate, Loss of consciousness, Cognitive disorder, Blood pressure measurement

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
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: 80/46 mmHg w/ 60bpm. Patient reports feeling "hot" and was visibly sweating. Skin was pale.
CDC 'Split Type':

Write-up: Patient reported feeling dizzy. Advised the patient to remain seated. Patient lost consciousness and fell to the ground. Sat patient upright and began screening for medical history. Cognition was low and speech was quiet. Measured blood pressure and pulse (80/46 mmHg pulse of 60bpm).

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1172613&WAYBACKHISTORY=ON

Government Disclaimer on use of this data


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