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From the 6/4/2021 release of VAERS data:

This is VAERS ID 1184894



Case Details

VAERS ID: 1184894 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Anxiety, Cough, Dizziness
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient reported feeling dizzy, anxious, and having a dry cough Patient had no history of COVID, syncopal episodes, or anxiety with vaccines or blood work Patient stated eating and drinking water before vaccination, patient stated symptoms improved Patient seen by medical team, vitals were stable Patient provided with water and refused medical transport and signed AMA form Patient will be driven home by sister


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1184894


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