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This is VAERS ID 1454380

History of Changes from the VAERS Wayback Machine

First Appeared on 7/9/2021

VAERS ID: 1454380
VAERS Form:2
Age:19.0
Sex:Male
Location:Connecticut
Vaccinated:2021-07-07
Onset:2021-07-07
Submitted:0000-00-00
Entered:2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821281 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cough, Hypoaesthesia, Pallor, Visual impairment

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: None
Current Illness: none
Preexisting Conditions: none
Allergies: Minocycline
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received dose of vaccine. About 2 minutes later he started coughing. A minute later he started to hunch over in his chair. I went over to make sure if he fainted that he would not fall. He described numbing and tingling in both arms and face. He was having difficulty seeing complaining of seeing white. We took his Bp it was 116/70 and pulse of 63. Ge appeared pale and white. We called for ems, and by the time EMS arrived he was feeling better his color had returned in his face. Patient was able to walk and leave store under his own power and didn''t need to be transported.

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