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This is VAERS ID 1177617

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1177617
VAERS Form:2
Age:63.0
Sex:Male
Location:California
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 59676058015 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Fall, Head injury, Hypotension

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PATIENT WAS ADVISED TO WAIT FOR 15 MINUTES. THE PATIENT AFTER LEAVING THE PHARMACY FELL ON THE GROUND REPORTED BY ANOTHER PERSON WHO CAME TO THE PHARMACY. HE SAID HE GOT DIZZY AND FELL AND SUFFERED A WOUND ON HIS HEAD. PARAMEDICS CAME AND THE BLOOD PRESSURE WAS FOUND TO BE LOW. PATIENT WAS BROUGHT TO THE HOSPITAL


Changed on 5/7/2021

VAERS ID: 1177617 Before After
VAERS Form:2
Age:63.0
Sex:Male
Location:California
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 59676058015 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Fall, Head injury, Hypotension

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PATIENT WAS ADVISED TO WAIT FOR 15 MINUTES. THE PATIENT AFTER LEAVING THE PHARMACY FELL ON THE GROUND REPORTED BY ANOTHER PERSON WHO CAME TO THE PHARMACY. HE SAID HE GOT DIZZY AND FELL AND SUFFERED A WOUND ON HIS HEAD. PARAMEDICS CAME AND THE BLOOD PRESSURE WAS FOUND TO BE LOW. PATIENT WAS BROUGHT TO THE HOSPITAL


Changed on 5/14/2021

VAERS ID: 1177617 Before After
VAERS Form:2
Age:63.0
Sex:Male
Location:California
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 59676058015 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Fall, Head injury, Hypotension

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: PATIENT WAS ADVISED TO WAIT FOR 15 MINUTES. THE PATIENT AFTER LEAVING THE PHARMACY FELL ON THE GROUND REPORTED BY ANOTHER PERSON WHO CAME TO THE PHARMACY. HE SAID HE GOT DIZZY AND FELL AND SUFFERED A WOUND ON HIS HEAD. PARAMEDICS CAME AND THE BLOOD PRESSURE WAS FOUND TO BE LOW. PATIENT WAS BROUGHT TO THE HOSPITAL

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1177617&WAYBACKHISTORY=ON

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