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This is VAERS ID 1181735

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History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1181735
VAERS Form:2
Age:53.0
Sex:Female
Location:Rhode Island
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 041A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Eye movement disorder, Glassy eyes

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: Unknown
CDC 'Split Type':

Write-up: Observer noticed patient eyes glazed , Call pharmacist over - pharmacist spoke with patient, he noticed eyes rolling up and yelled to call 911 -then asked patient her name And where she was - did Not answer - pharmacist administered epi pen. Paramedics arrived


Changed on 5/7/2021

VAERS ID: 1181735 Before After
VAERS Form:2
Age:53.0
Sex:Female
Location:Rhode Island
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 041A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Eye movement disorder, Glassy eyes

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: Unknown
CDC 'Split Type':

Write-up: Observer noticed patient eyes glazed , Call pharmacist over - pharmacist spoke with patient, he noticed eyes rolling up and yelled to call 911 -then asked patient her name And where she was - did Not answer - pharmacist administered epi pen. Paramedics arrived


Changed on 5/14/2021

VAERS ID: 1181735 Before After
VAERS Form:2
Age:53.0
Sex:Female
Location:Rhode Island
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 041A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Eye movement disorder, Glassy eyes

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: Unknown
CDC 'Split Type':

Write-up: Observer noticed patient eyes glazed , Call pharmacist over - pharmacist spoke with patient, he noticed eyes rolling up and yelled to call 911 -then asked patient her name And where she was - did Not answer - pharmacist administered epi pen. Paramedics arrived

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1181735&WAYBACKHISTORY=ON


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