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This is VAERS ID 1179363

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1179363
VAERS Form:2
Age:65.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-04-07
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Tachycardia, Tremor

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: Systemic: Shakiness-Severe, Systemic: Tachycardia-Severe, Additional Details: uncontrolable shaking. patient stated that benadryl has helped her in the past with this type of reaction. gave benadryl. patient has a history of having reactions to vaccines. 911 was called and brought her to the hospital.


Changed on 5/7/2021

VAERS ID: 1179363 Before After
VAERS Form:2
Age:65.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-04-07
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Tachycardia, Tremor

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: Systemic: Shakiness-Severe, Systemic: Tachycardia-Severe, Additional Details: uncontrolable shaking. patient stated that benadryl has helped her in the past with this type of reaction. gave benadryl. patient has a history of having reactions to vaccines. 911 was called and brought her to the hospital.


Changed on 5/14/2021

VAERS ID: 1179363 Before After
VAERS Form:2
Age:65.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-04-07
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Tachycardia, Tremor

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: Systemic: Shakiness-Severe, Systemic: Tachycardia-Severe, Additional Details: uncontrolable shaking. patient stated that benadryl has helped her in the past with this type of reaction. gave benadryl. patient has a history of having reactions to vaccines. 911 was called and brought her to the hospital.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1179363&WAYBACKHISTORY=ON

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