National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1185915

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1185915
VAERS Form:2
Age:53.0
Sex:Male
Location:California
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 043A21A / 1 RA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Heart rate decreased, Hyperhidrosis, Hypotension, Pallor, Syncope

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: None
Current Illness: None
Preexisting Conditions: Syncopal episodes, hypotension, anaphylaxis
Allergies: Shrimp
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient had syncopal episode witnessed by nursing staff Patient appeared pale and diaphoretic Patient seen by medical team and provided with water Patient had history of syncopal episodes and hypotension Patient sent to The hospital via ambulance for low blood pressure and low heart rate


Changed on 5/7/2021

VAERS ID: 1185915 Before After
VAERS Form:2
Age:53.0
Sex:Male
Location:California
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 043A21A / 1 RA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Heart rate decreased, Hyperhidrosis, Hypotension, Pallor, Syncope

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: None
Current Illness: None
Preexisting Conditions: Syncopal episodes, hypotension, anaphylaxis
Allergies: Shrimp Shrimp
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient had syncopal episode witnessed by nursing staff Patient appeared pale and diaphoretic Patient seen by medical team and provided with water Patient had history of syncopal episodes and hypotension Patient sent to The hospital via ambulance for low blood pressure and low heart rate


Changed on 5/14/2021

VAERS ID: 1185915 Before After
VAERS Form:2
Age:53.0
Sex:Male
Location:California
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 043A21A / 1 RA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Heart rate decreased, Hyperhidrosis, Hypotension, Pallor, Syncope

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: None
Current Illness: None
Preexisting Conditions: Syncopal episodes, hypotension, anaphylaxis
Allergies: Shrimp Shrimp
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient had syncopal episode witnessed by nursing staff Patient appeared pale and diaphoretic Patient seen by medical team and provided with water Patient had history of syncopal episodes and hypotension Patient sent to The hospital via ambulance for low blood pressure and low heart rate

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1185915&WAYBACKHISTORY=ON


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