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This is VAERS ID 1180658

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1180658
VAERS Form:2
Age:62.0
Sex:Unknown
Location:Washington
Vaccinated:2021-04-01
Onset:2021-04-01
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Hyperhidrosis, Pallor, Unresponsive to stimuli

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: unknown
Diagnostic Lab Data: code team called, patient woke up and started responding right before epi injection administration Transferred to ED
CDC 'Split Type':

Write-up: unresponsive, pale, diaphoretic, SBP 80s HR 50s


Changed on 5/7/2021

VAERS ID: 1180658 Before After
VAERS Form:2
Age:62.0
Sex:Unknown
Location:Washington
Vaccinated:2021-04-01
Onset:2021-04-01
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Hyperhidrosis, Pallor, Unresponsive to stimuli

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: unknown unknown
Diagnostic Lab Data: code team called, patient woke up and started responding right before epi injection administration Transferred to ED
CDC 'Split Type':

Write-up: unresponsive, pale, diaphoretic, SBP 80s HR 50s


Changed on 5/14/2021

VAERS ID: 1180658 Before After
VAERS Form:2
Age:62.0
Sex:Unknown
Location:Washington
Vaccinated:2021-04-01
Onset:2021-04-01
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 - / IM

Administered by: Private      Purchased by: ??
Symptoms: Hyperhidrosis, Pallor, Unresponsive to stimuli

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: unknown unknown
Diagnostic Lab Data: code team called, patient woke up and started responding right before epi injection administration Transferred to ED
CDC 'Split Type':

Write-up: unresponsive, pale, diaphoretic, SBP 80s HR 50s

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1180658&WAYBACKHISTORY=ON

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