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This is VAERS ID 1176116

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1176116
VAERS Form:2
Age:47.0
Sex:Male
Location:Nevada
Vaccinated:2021-04-06
Onset:2021-04-06
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dyskinesia, Injection site haemorrhage, Unresponsive to stimuli

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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received the vaccine. Immunizing tech stated: the patient seemed fine at the time of the shot. After administration of the shot the patient began to bleed out of injection site (like normal). The immunizing tech swabbed the area with cotton and placed a Band-Aid on the patient then stepped back into the pharmacy to grab another band aid while the patient remained at the immunization chair. The tech applied another band aid and told the patient to wait 15 minutes after the immunization and directed him to a waiting chair. The tech came back into the pharmacy and was cleaning the immunization basket when the patient''s wife yelled for help. At this point I went out to the patient. Another tech called 911, another grabbed a nearby EpiPen. The immunizing tech grabbed the e-kit while I was out with the patient while he was unresponsive. Patient was unresponsive and slouched in chair. His wife and I supported the neck of the patient and laid him on the floor. I checked pulse and breathing to which both were present. Patient was still unresponsive and making strange movements. Pulse and breathing remained present and then the patient became responsive relatively quickly. At this point patient responsive and answering questions and moving fine. He asked if he had passed out then stated, he had a phobia of needles and said he felt nauseated. (wife previously stated he had a fear of injections). Soon after the ambulance showed up and I told the paramedics the above story. After a few more minutes I checked in with the paramedics and they said the patient was doing fine. Lastly, he was taken out of store with paramedics.


Changed on 5/7/2021

VAERS ID: 1176116 Before After
VAERS Form:2
Age:47.0
Sex:Male
Location:Nevada
Vaccinated:2021-04-06
Onset:2021-04-06
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dyskinesia, Injection site haemorrhage, Unresponsive to stimuli

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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received the vaccine. Immunizing tech stated: the patient seemed fine at the time of the shot. After administration of the shot the patient began to bleed out of injection site (like normal). The immunizing tech swabbed the area with cotton and placed a Band-Aid on the patient then stepped back into the pharmacy to grab another band aid while the patient remained at the immunization chair. The tech applied another band aid and told the patient to wait 15 minutes after the immunization and directed him to a waiting chair. The tech came back into the pharmacy and was cleaning the immunization basket when the patient''s wife yelled for help. At this point I went out to the patient. Another tech called 911, another grabbed a nearby EpiPen. The immunizing tech grabbed the e-kit while I was out with the patient while he was unresponsive. Patient was unresponsive and slouched in chair. His wife and I supported the neck of the patient and laid him on the floor. I checked pulse and breathing to which both were present. Patient was still unresponsive and making strange movements. Pulse and breathing remained present and then the patient became responsive relatively quickly. At this point patient responsive and answering questions and moving fine. He asked if he had passed out then stated, he had a phobia of needles and said he felt nauseated. (wife previously stated he had a fear of injections). Soon after the ambulance showed up and I told the paramedics the above story. After a few more minutes I checked in with the paramedics and they said the patient was doing fine. Lastly, he was taken out of store with paramedics.


Changed on 5/14/2021

VAERS ID: 1176116 Before After
VAERS Form:2
Age:47.0
Sex:Male
Location:Nevada
Vaccinated:2021-04-06
Onset:2021-04-06
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dyskinesia, Injection site haemorrhage, Unresponsive to stimuli

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: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received the vaccine. Immunizing tech stated: the patient seemed fine at the time of the shot. After administration of the shot the patient began to bleed out of injection site (like normal). The immunizing tech swabbed the area with cotton and placed a Band-Aid on the patient then stepped back into the pharmacy to grab another band aid while the patient remained at the immunization chair. The tech applied another band aid and told the patient to wait 15 minutes after the immunization and directed him to a waiting chair. The tech came back into the pharmacy and was cleaning the immunization basket when the patient''s wife yelled for help. At this point I went out to the patient. Another tech called 911, another grabbed a nearby EpiPen. The immunizing tech grabbed the e-kit while I was out with the patient while he was unresponsive. Patient was unresponsive and slouched in chair. His wife and I supported the neck of the patient and laid him on the floor. I checked pulse and breathing to which both were present. Patient was still unresponsive and making strange movements. Pulse and breathing remained present and then the patient became responsive relatively quickly. At this point patient responsive and answering questions and moving fine. He asked if he had passed out then stated, he had a phobia of needles and said he felt nauseated. (wife previously stated he had a fear of injections). Soon after the ambulance showed up and I told the paramedics the above story. After a few more minutes I checked in with the paramedics and they said the patient was doing fine. Lastly, he was taken out of store with paramedics.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1176116&WAYBACKHISTORY=ON

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