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This is VAERS ID 1330753

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1330753
VAERS Form:2
Age:85.0
Sex:Female
Location:California
Vaccinated:2021-05-19
Onset:2021-05-19
Submitted:0000-00-00
Entered:2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808979 / N/A RA / IM

Administered by: Senior Living      Purchased by: ??
Symptoms: Confusional state, Hypoxia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown, but per facility nurse, pt is NOT on blood thinners.
Current Illness:
Preexisting Conditions:
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: J&J vaccine was administered to patient. Consent form states that patient will be receiving J&J vaccine today. Pt is confused per medical baseline. Notified facility nurse, RN that I will be given J&J to patient and was okay with giving. After vaccine was given a second facility nurse, RN confirmed that pt was supposed to received second dose of Pfizer vaccine today. Pt was closely monitored in area for 30 minutes, facility Dr was notified. No acute distress noted, vital sign stable, no reactions noted, no active bleeding noted during 30 minutes of observation. Pt was taken back to her room and 15 minutes after observation at around 09:35AM, facility staff notified pt was desatting, was placed on oxygen and ambulance was called and taken to emergency room.

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