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This is VAERS ID 1228882

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1228882
VAERS Form:2
Age:72.0
Sex:Female
Location:Florida
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dizziness, Heart rate decreased, Loss of consciousness, Pallor, Presyncope, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: per patient: see last box (additional items) Prescriptions taken at time of vaccine as per patient: 1) pantoprazole 40mg 2) fluoxetine 10mg 3) atorvastatin 20mg 4) aspirin 81mg 5) mometasone nasal spray 6) fluoxetine 10mg 7) mvi 8) calcium
Current Illness: endoscopy 3/31/21 which she reported"fungus growing in throat"
Preexisting Conditions: chronic cough, acid reflux
Allergies: Scallops
Diagnostic Lab Data: need to obtain from patient.
CDC 'Split Type':

Write-up: This is a spouse. Medical Center do not have this patient''s medical record and is reporting the reaction on her behalf based on available information. Patient reported she was having brunch 4/11/21 am and started feeling very dizzy (was dining outside) and her son informed her that she was very pale. Her stomach started to rumble and threw up. Son called the ambulance due to "low pulse" and "loss of consciousness". She was treated at ER with iv fluids and anti-nausea medicine and was discharged that day (4/11/21) around 1pm with diagnosis of "Vagal Response". She recalled being in the ambulance around 4/11@11:10am.


Changed on 5/7/2021

VAERS ID: 1228882 Before After
VAERS Form:2
Age:72.0
Sex:Female
Location:Florida
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dizziness, Heart rate decreased, Loss of consciousness, Pallor, Presyncope, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: per patient: see last box (additional items) Prescriptions taken at time of vaccine as per patient: 1) pantoprazole 40mg 2) fluoxetine 10mg 3) atorvastatin 20mg 4) aspirin 81mg 5) mometasone nasal spray 6) fluoxetine 10mg 7) mvi 8) calcium
Current Illness: endoscopy 3/31/21 which she reported"fungus growing in throat"
Preexisting Conditions: chronic cough, acid reflux
Allergies: Scallops Scallops
Diagnostic Lab Data: need to obtain from patient.
CDC 'Split Type':

Write-up: This is a spouse. Medical Center do not have this patient''s medical record and is reporting the reaction on her behalf based on available information. Patient reported she was having brunch 4/11/21 am and started feeling very dizzy (was dining outside) and her son informed her that she was very pale. Her stomach started to rumble and threw up. Son called the ambulance due to "low pulse" and "loss of consciousness". She was treated at ER with iv fluids and anti-nausea medicine and was discharged that day (4/11/21) around 1pm with diagnosis of "Vagal Response". She recalled being in the ambulance around 4/11@11:10am.


Changed on 5/14/2021

VAERS ID: 1228882 Before After
VAERS Form:2
Age:72.0
Sex:Female
Location:Florida
Vaccinated:2021-04-10
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dizziness, Heart rate decreased, Loss of consciousness, Pallor, Presyncope, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
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: per patient: see last box (additional items) Prescriptions taken at time of vaccine as per patient: 1) pantoprazole 40mg 2) fluoxetine 10mg 3) atorvastatin 20mg 4) aspirin 81mg 5) mometasone nasal spray 6) fluoxetine 10mg 7) mvi 8) calcium
Current Illness: endoscopy 3/31/21 which she reported"fungus growing in throat"
Preexisting Conditions: chronic cough, acid reflux
Allergies: Scallops Scallops
Diagnostic Lab Data: need to obtain from patient.
CDC 'Split Type':

Write-up: This is a spouse. Medical Center do not have this patient''s medical record and is reporting the reaction on her behalf based on available information. Patient reported she was having brunch 4/11/21 am and started feeling very dizzy (was dining outside) and her son informed her that she was very pale. Her stomach started to rumble and threw up. Son called the ambulance due to "low pulse" and "loss of consciousness". She was treated at ER with iv fluids and anti-nausea medicine and was discharged that day (4/11/21) around 1pm with diagnosis of "Vagal Response". She recalled being in the ambulance around 4/11@11:10am.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1228882&WAYBACKHISTORY=ON


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