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This is VAERS ID 1178799

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1178799
VAERS Form:2
Age:29.0
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 042A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Mental impairment, Pallor, Somnolence

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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: At approximately 4 pm, I gave the patient a Janssen covid-19 vaccination. I asked the patient to sit for 15 minutes for observation. About 10 minutes later I was notified someone wasn''t doing well. I went to the patient and he was hunched down and looked pale and he stated he was very dizzy. I asked him if he had trouble breathing and he stated he had not. He appeared like he was about to pass out, I was asking him questions about his state and he wasn''t being coherent. I told him I was going to give an EpiPen and call 911. I gave him the EpiPen in his outer thigh. EMS came 5 minutes later. A few hours later I got a call from a close by asking if I had given him a Benadryl because he was feeling drowsy. I asked his status and the nurse stated he was doing fine.


Changed on 5/7/2021

VAERS ID: 1178799 Before After
VAERS Form:2
Age:29.0
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 042A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Mental impairment, Pallor, Somnolence

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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKDA NKDA
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: At approximately 4 pm, I gave the patient a Janssen covid-19 vaccination. I asked the patient to sit for 15 minutes for observation. About 10 minutes later I was notified someone wasn''t doing well. I went to the patient and he was hunched down and looked pale and he stated he was very dizzy. I asked him if he had trouble breathing and he stated he had not. He appeared like he was about to pass out, I was asking him questions about his state and he wasn''t being coherent. I told him I was going to give an EpiPen and call 911. I gave him the EpiPen in his outer thigh. EMS came 5 minutes later. A few hours later I got a call from a close by asking if I had given him a Benadryl because he was feeling drowsy. I asked his status and the nurse stated he was doing fine.


Changed on 5/14/2021

VAERS ID: 1178799 Before After
VAERS Form:2
Age:29.0
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 042A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Mental impairment, Pallor, Somnolence

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: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: NKDA NKDA
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: At approximately 4 pm, I gave the patient a Janssen covid-19 vaccination. I asked the patient to sit for 15 minutes for observation. About 10 minutes later I was notified someone wasn''t doing well. I went to the patient and he was hunched down and looked pale and he stated he was very dizzy. I asked him if he had trouble breathing and he stated he had not. He appeared like he was about to pass out, I was asking him questions about his state and he wasn''t being coherent. I told him I was going to give an EpiPen and call 911. I gave him the EpiPen in his outer thigh. EMS came 5 minutes later. A few hours later I got a call from a close by asking if I had given him a Benadryl because he was feeling drowsy. I asked his status and the nurse stated he was doing fine.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1178799&WAYBACKHISTORY=ON

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