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This is VAERS ID 1697357

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1697357
VAERS Form:2
Age:77.0
Sex:Female
Location:Maine
Vaccinated:2021-09-14
Onset:2021-09-14
Submitted:0000-00-00
Entered:2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Dysphagia, Hypopnoea, Respiration abnormal, Respiratory rate increased, Interchange of vaccine products

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: Anaphylaxis from Moderna Covid 19 first dose
Other Medications: Unknown
Current Illness: unknown
Preexisting Conditions: Diabetic, High blood pressure, Chronic Kidney Disease.
Allergies: Previous anaphylaxis reaction to Moderna Covid-19 Vaccine. (Cleared today by patient''s PCP to receive Johnson and Johnson vaccine).
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Patient became unable to swallow, then tripod and purse lip breathing. Patient stated it felt like the Moderna Anaphylaxis reaction she previously had. Respirations became shallow and rapid. Administered Epi 0.3 mg into left anterior lateral quad and called 9-1-1. Patient respirations after administration of Epi was 22 bpm, P 97, SaO2 98% on Room Air, B/P 110/84. Patient taken by ambulance to ED.

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