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This is VAERS ID 1184868

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1184868
VAERS Form:2
Age:18.0
Sex:Female
Location:Illinois
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 / N/A LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Confusional state, Loss of consciousness, Syncope, Tremor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: blood pressure and heart rate taken by EMTs 4/9/21-- results unknown.
CDC 'Split Type':

Write-up: Patient fainted within minutes after receiving vaccine. Fell out of chair and blacked out. She woke up immediately but felt very confused and shakey. 911 was called and vitals were taken by EMTs. Patient was picked up by her parents.


Changed on 5/7/2021

VAERS ID: 1184868 Before After
VAERS Form:2
Age:18.0
Sex:Female
Location:Illinois
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 / N/A LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Confusional state, Loss of consciousness, Syncope, Tremor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: blood pressure and heart rate taken by EMTs 4/9/21-- results unknown.
CDC 'Split Type':

Write-up: Patient fainted within minutes after receiving vaccine. Fell out of chair and blacked out. She woke up immediately but felt very confused and shakey. 911 was called and vitals were taken by EMTs. Patient was picked up by her parents.


Changed on 5/14/2021

VAERS ID: 1184868 Before After
VAERS Form:2
Age:18.0
Sex:Female
Location:Illinois
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 / N/A LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Confusional state, Loss of consciousness, Syncope, Tremor

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: blood pressure and heart rate taken by EMTs 4/9/21-- results unknown.
CDC 'Split Type':

Write-up: Patient fainted within minutes after receiving vaccine. Fell out of chair and blacked out. She woke up immediately but felt very confused and shakey. 911 was called and vitals were taken by EMTs. Patient was picked up by her parents.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1184868&WAYBACKHISTORY=ON


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