National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 4/1/2021 release of VAERS data (an older release, current is 10/8/2021):

This is VAERS ID 1089709



Case Details

VAERS ID: 1089709 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-03-10
Onset:2021-03-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Contusion, Dyspnoea, Eye movement disorder, Pallor, Peripheral swelling, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Cardiac failure (broad), Anaphylactic reaction (broad), Angioedema (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Accidents and injuries (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Ocular motility disorders (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril
Current Illness: Nothing
Preexisting Conditions: High Blood Pressure
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: After receiving the vaccine with in minutes the patients left arm began to swell and bruise. He began to become pale and his eyes rolled back into his head and passed out. He woke up a min later and had SOB. Very pale and almost threw up. Paramedics and Firefighters were called. The eveulated the patients and gave him a liter of sodium choride. His Heart Rate was in the 30''s. After several min and a liter of fluid, patient was alert. Once stable he was transported to Hospital.


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210401&IDNUMBER=1089709

Government Disclaimer on use of this data


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166