National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 1186046

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1186046
VAERS Form:2
Age:19.0
Sex:Male
Location:Unknown
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 2002A21A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Dizziness, Contusion

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: A + O x 4 Pain 1/10 10:00 BP 100/5 HR 70 O2 97% 10:05 BP 121/76 HR 79 O2 100%
CDC 'Split Type':

Write-up: Pt sat for 15 mins, got up started to walk felt dizzy and fell down, hit head on wall. bruise on head above left eye 1" x1/4" Pt stated this is a typical reaction to blood draw


Changed on 5/7/2021

VAERS ID: 1186046 Before After
VAERS Form:2
Age:19.0
Sex:Male
Location:Unknown
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 2002A21A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Dizziness, Contusion

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: A + O x 4 Pain 1/10 10:00 BP 100/5 HR 70 O2 97% 10:05 BP 121/76 HR 79 O2 100%
CDC 'Split Type':

Write-up: Pt sat for 15 mins, got up started to walk felt dizzy and fell down, hit head on wall. bruise on head above left eye 1" x1/4" Pt stated this is a typical reaction to blood draw


Changed on 5/14/2021

VAERS ID: 1186046 Before After
VAERS Form:2
Age:19.0
Sex:Male
Location:Unknown
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 2002A21A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Dizziness, Contusion

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: A + O x 4 Pain 1/10 10:00 BP 100/5 HR 70 O2 97% 10:05 BP 121/76 HR 79 O2 100%
CDC 'Split Type':

Write-up: Pt sat for 15 mins, got up started to walk felt dizzy and fell down, hit head on wall. bruise on head above left eye 1" x1/4" Pt stated this is a typical reaction to blood draw

New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1186046&WAYBACKHISTORY=ON


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