National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1185165

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1185165
VAERS Form:2
Age:56.0
Sex:Male
Location:Maryland
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: Dizziness, Hypotension, Nausea, Presyncope, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: VASOVAGEL
Other Medications: HCTZ, irbersartan
Current Illness: none known
Preexisting Conditions: HTN
Allergies: bactrim, cozaar, lisinopril
Diagnostic Lab Data: n/a BP down to 106/85
CDC 'Split Type':

Write-up: + lightheaded and nausea, and then syncope followed by hypotension consistent with vasovagal response.


Changed on 5/7/2021

VAERS ID: 1185165 Before After
VAERS Form:2
Age:56.0
Sex:Male
Location:Maryland
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: Dizziness, Hypotension, Nausea, Presyncope, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: VASOVAGEL
Other Medications: HCTZ, irbersartan
Current Illness: none known
Preexisting Conditions: HTN
Allergies: bactrim, cozaar, lisinopril lisinopril
Diagnostic Lab Data: n/a BP down to 106/85
CDC 'Split Type':

Write-up: + lightheaded and nausea, and then syncope followed by hypotension consistent with vasovagal response.


Changed on 5/14/2021

VAERS ID: 1185165 Before After
VAERS Form:2
Age:56.0
Sex:Male
Location:Maryland
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: Dizziness, Hypotension, Nausea, Presyncope, Syncope

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations: VASOVAGEL
Other Medications: HCTZ, irbersartan
Current Illness: none known
Preexisting Conditions: HTN
Allergies: bactrim, cozaar, lisinopril lisinopril
Diagnostic Lab Data: n/a BP down to 106/85
CDC 'Split Type':

Write-up: + lightheaded and nausea, and then syncope followed by hypotension consistent with vasovagal response.

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1185165&WAYBACKHISTORY=ON


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