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This is VAERS ID 1177052

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1177052
VAERS Form:2
Age:22.0
Sex:Male
Location:North Carolina
Vaccinated:2021-04-07
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dizziness, Vital signs 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: Losartan, hydrochlorothiazide
Current Illness: None
Preexisting Conditions: History of panic/anxiety attacks, sleep apnea uses bipap,
Allergies: KNA
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Pt stated he felt faint while sitting in waiting area and like he was going to pass out. Cot brought over and staff assisted pt to lie on cot. EMT took over assessment of pt. VS temp 97.4, p 76, BP 123/69, resp. 15, blood sugar 96. Pt never lost consciousness completely. Pt given an ice pack for forehead.PT oriented to person , place, time, event. Family present and states pt has history of passing out with immunizations. EMT assessed pt and called for transport. Pt transported via EMS squad unit to Hospital at 2:05 pm.


Changed on 5/7/2021

VAERS ID: 1177052 Before After
VAERS Form:2
Age:22.0
Sex:Male
Location:North Carolina
Vaccinated:2021-04-07
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dizziness, Vital signs 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: Losartan, hydrochlorothiazide
Current Illness: None
Preexisting Conditions: History of panic/anxiety attacks, sleep apnea uses bipap,
Allergies: KNA KNA
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Pt stated he felt faint while sitting in waiting area and like he was going to pass out. Cot brought over and staff assisted pt to lie on cot. EMT took over assessment of pt. VS temp 97.4, p 76, BP 123/69, resp. 15, blood sugar 96. Pt never lost consciousness completely. Pt given an ice pack for forehead.PT oriented to person , place, time, event. Family present and states pt has history of passing out with immunizations. EMT assessed pt and called for transport. Pt transported via EMS squad unit to Hospital at 2:05 pm.


Changed on 5/14/2021

VAERS ID: 1177052 Before After
VAERS Form:2
Age:22.0
Sex:Male
Location:North Carolina
Vaccinated:2021-04-07
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dizziness, Vital signs 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: Losartan, hydrochlorothiazide
Current Illness: None
Preexisting Conditions: History of panic/anxiety attacks, sleep apnea uses bipap,
Allergies: KNA KNA
Diagnostic Lab Data: NA
CDC 'Split Type':

Write-up: Pt stated he felt faint while sitting in waiting area and like he was going to pass out. Cot brought over and staff assisted pt to lie on cot. EMT took over assessment of pt. VS temp 97.4, p 76, BP 123/69, resp. 15, blood sugar 96. Pt never lost consciousness completely. Pt given an ice pack for forehead.PT oriented to person , place, time, event. Family present and states pt has history of passing out with immunizations. EMT assessed pt and called for transport. Pt transported via EMS squad unit to Hospital at 2:05 pm.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1177052&WAYBACKHISTORY=ON

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