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This is VAERS ID 1376037

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1376037
VAERS Form:2
Age:20.0
Sex:Female
Location:Virginia
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cold sweat, Malaise, Tinnitus, Unresponsive to stimuli, Eye movement disorder

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: birth control tablets
Current Illness: none
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient said she felt ill. became unresponsive. Would fallen if we didn''t support in chair. It appeared her eyes rolled back. Airway breathing was monitor. and fine. Called 911. She started to come to but was extremely clammy and complained of ring in ears. she was glad EMT''s checked out but declined to go to hospital with them. We kept checking he till a friend came to pick her up.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1376037&WAYBACKHISTORY=ON


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