National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1176840

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1176840
VAERS Form:2
Age:78.0
Sex:Female
Location:Arizona
Vaccinated:2021-04-02
Onset:2021-04-02
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / UNK LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Chest discomfort, Chest pain, Hypertension

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: PCN
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: During observation period after COVID vaccine administration, client reported chest pain/pressure 7/10. EMS called. Client escorted to isolated area, mask removed and vital signs taken. Client was alert and oriented x3, no difficulties speaking or answering questions. Neuro check and vitals taken until EMS on site. Emergency Care Flow completed. Client was transported to near by hospital by EMS due to unstable/high blood pressure. Vital signs reported by EMS before transport: BP 210/92, HR 87, Respirations 16, O2 sat 97%, blood sugar 78.


Changed on 5/7/2021

VAERS ID: 1176840 Before After
VAERS Form:2
Age:78.0
Sex:Female
Location:Arizona
Vaccinated:2021-04-02
Onset:2021-04-02
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / UNK LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Chest discomfort, Chest pain, Hypertension

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: PCN PCN
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: During observation period after COVID vaccine administration, client reported chest pain/pressure 7/10. EMS called. Client escorted to isolated area, mask removed and vital signs taken. Client was alert and oriented x3, no difficulties speaking or answering questions. Neuro check and vitals taken until EMS on site. Emergency Care Flow completed. Client was transported to near by hospital by EMS due to unstable/high blood pressure. Vital signs reported by EMS before transport: BP 210/92, HR 87, Respirations 16, O2 sat 97%, blood sugar 78.


Changed on 5/14/2021

VAERS ID: 1176840 Before After
VAERS Form:2
Age:78.0
Sex:Female
Location:Arizona
Vaccinated:2021-04-02
Onset:2021-04-02
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / UNK LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Chest discomfort, Chest pain, Hypertension

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: PCN PCN
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: During observation period after COVID vaccine administration, client reported chest pain/pressure 7/10. EMS called. Client escorted to isolated area, mask removed and vital signs taken. Client was alert and oriented x3, no difficulties speaking or answering questions. Neuro check and vitals taken until EMS on site. Emergency Care Flow completed. Client was transported to near by hospital by EMS due to unstable/high blood pressure. Vital signs reported by EMS before transport: BP 210/92, HR 87, Respirations 16, O2 sat 97%, blood sugar 78.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1176840&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