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This is VAERS ID 1184931

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1184931
VAERS Form:2
Age:60.0
Sex:Female
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 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Dry mouth, Vision blurred

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: Per patient, reaction to influenza. Date unknown.
Other Medications: Zyrtec, Vit D3, Tolteridine Tartrate ER, Synthroid, Nexium, Lisinopril, Hydrixizine, HCTZ, gabapentin, fluoxetidine, fluconazole, fentanyl patch, estradiol, ergocalciferol, diazapam, advair discus, flonase.
Current Illness: None
Preexisting Conditions: Unknown
Allergies: Propulsid, Iodine, latex, bee stings, steroids, tomatoes, shellfish, oral contrast, gatorade, amocicillin, avelox, baclofen, elmiron, erythromycin, hydrocodone, acetaminophen, mucinex, naratriptan, nasonex, oxycontin, prednisone, rizatriptan benzoate, sumatriptan, tetracycline, tramadol, zanaflex, influenza vaccine, higher dose penicillins.
Diagnostic Lab Data: Unknown, as patient was brought to the emergency department.
CDC 'Split Type':

Write-up: Patient complained of feeling a dry mouth and blurry vision. She felt that this was a sign of an allergic reaction. EPI pen was administered and patient was brought to the emergency room.


Changed on 5/7/2021

VAERS ID: 1184931 Before After
VAERS Form:2
Age:60.0
Sex:Female
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 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Dry mouth, Vision blurred

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: Per patient, reaction to influenza. Date unknown.
Other Medications: Zyrtec, Vit D3, Tolteridine Tartrate ER, Synthroid, Nexium, Lisinopril, Hydrixizine, HCTZ, gabapentin, fluoxetidine, fluconazole, fentanyl patch, estradiol, ergocalciferol, diazapam, advair discus, flonase.
Current Illness: None
Preexisting Conditions: Unknown
Allergies: Propulsid, Iodine, latex, bee stings, steroids, tomatoes, shellfish, oral contrast, gatorade, amocicillin, avelox, baclofen, elmiron, erythromycin, hydrocodone, acetaminophen, mucinex, naratriptan, nasonex, oxycontin, prednisone, rizatriptan benzoate, sumatriptan, tetracycline, tramadol, zanaflex, influenza vaccine, higher dose penicillins. penicillins.
Diagnostic Lab Data: Unknown, as patient was brought to the emergency department.
CDC 'Split Type':

Write-up: Patient complained of feeling a dry mouth and blurry vision. She felt that this was a sign of an allergic reaction. EPI pen was administered and patient was brought to the emergency room.


Changed on 5/14/2021

VAERS ID: 1184931 Before After
VAERS Form:2
Age:60.0
Sex:Female
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 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Dry mouth, Vision blurred

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: Per patient, reaction to influenza. Date unknown.
Other Medications: Zyrtec, Vit D3, Tolteridine Tartrate ER, Synthroid, Nexium, Lisinopril, Hydrixizine, HCTZ, gabapentin, fluoxetidine, fluconazole, fentanyl patch, estradiol, ergocalciferol, diazapam, advair discus, flonase.
Current Illness: None
Preexisting Conditions: Unknown
Allergies: Propulsid, Iodine, latex, bee stings, steroids, tomatoes, shellfish, oral contrast, gatorade, amocicillin, avelox, baclofen, elmiron, erythromycin, hydrocodone, acetaminophen, mucinex, naratriptan, nasonex, oxycontin, prednisone, rizatriptan benzoate, sumatriptan, tetracycline, tramadol, zanaflex, influenza vaccine, higher dose penicillins. penicillins.
Diagnostic Lab Data: Unknown, as patient was brought to the emergency department.
CDC 'Split Type':

Write-up: Patient complained of feeling a dry mouth and blurry vision. She felt that this was a sign of an allergic reaction. EPI pen was administered and patient was brought to the emergency room.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1184931&WAYBACKHISTORY=ON


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