National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1184767

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1184767
VAERS Form:2
Age:38.0
Sex:Male
Location:New Hampshire
Vaccinated:2021-04-09
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Hyperhidrosis, Loss of consciousness, Seizure like phenomena

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

Write-up: Patient passed out within a couple minutes of injection, had seizure like activity, was sweating. He was alert shortly after. Ambulance came and took the patient


Changed on 5/7/2021

VAERS ID: 1184767 Before After
VAERS Form:2
Age:38.0
Sex:Male
Location:New Hampshire
Vaccinated:2021-04-09
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Hyperhidrosis, Loss of consciousness, Seizure like phenomena

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

Write-up: Patient passed out within a couple minutes of injection, had seizure like activity, was sweating. He was alert shortly after. Ambulance came and took the patient


Changed on 5/14/2021

VAERS ID: 1184767 Before After
VAERS Form:2
Age:38.0
Sex:Male
Location:New Hampshire
Vaccinated:2021-04-09
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / UNK LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Hyperhidrosis, Loss of consciousness, Seizure like phenomena

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

Write-up: Patient passed out within a couple minutes of injection, had seizure like activity, was sweating. He was alert shortly after. Ambulance came and took the patient

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1184767&WAYBACKHISTORY=ON


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166