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This is VAERS ID 1180807

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1180807
VAERS Form:2
Age:52.0
Sex:Female
Location:Michigan
Vaccinated:2021-04-08
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Anxiety, Hyperhidrosis, Tachycardia

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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: patient was vaccinated at 10:55 by 11:00 was anxious and pacing with tachycardia and sweating. at 11:05 patient was given 50mg diphenhydramine in liquid form (20cc) and EMT personnel arrived at 11:15 to evaluate patient. Patient chose to go hospital for evaluation


Changed on 5/7/2021

VAERS ID: 1180807 Before After
VAERS Form:2
Age:52.0
Sex:Female
Location:Michigan
Vaccinated:2021-04-08
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Anxiety, Hyperhidrosis, Tachycardia

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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: patient was vaccinated at 10:55 by 11:00 was anxious and pacing with tachycardia and sweating. at 11:05 patient was given 50mg diphenhydramine in liquid form (20cc) and EMT personnel arrived at 11:15 to evaluate patient. Patient chose to go hospital for evaluation


Changed on 5/14/2021

VAERS ID: 1180807 Before After
VAERS Form:2
Age:52.0
Sex:Female
Location:Michigan
Vaccinated:2021-04-08
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Anxiety, Hyperhidrosis, Tachycardia

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: none
Current Illness: none
Preexisting Conditions: none
Allergies: none none
Diagnostic Lab Data: unknown
CDC 'Split Type':

Write-up: patient was vaccinated at 10:55 by 11:00 was anxious and pacing with tachycardia and sweating. at 11:05 patient was given 50mg diphenhydramine in liquid form (20cc) and EMT personnel arrived at 11:15 to evaluate patient. Patient chose to go hospital for evaluation

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1180807&WAYBACKHISTORY=ON

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