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This is VAERS ID 1130931

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1130931
VAERS Form:2
Age:20.0
Sex:Male
Location:California
Vaccinated:2021-03-24
Onset:2021-03-24
Submitted:0000-00-00
Entered:2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dizziness, Syncope

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: Hx fainting, cardiac murmur
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt. reported feeling light headed, after sitting experienced a syncopal episode. BP 98/45 p 75. Pt. was revivied after about 35 seconds and stated feeling better. BP 112/72, p 76. Pt. stated has hx of syncope. Pt and family refused to be transferred via squad. Pt. states he will fu with PCP this week.


Changed on 5/7/2021

VAERS ID: 1130931 Before After
VAERS Form:2
Age:20.0
Sex:Male
Location:California
Vaccinated:2021-03-24
Onset:2021-03-24
Submitted:0000-00-00
Entered:2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 RA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dizziness, Syncope

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: Hx fainting, cardiac murmur
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Pt. reported feeling light headed, after sitting experienced a syncopal episode. BP 98/45 p 75. Pt. was revivied after about 35 seconds and stated feeling better. BP 112/72, p 76. Pt. stated has hx of syncope. Pt and family refused to be transferred via squad. Pt. states he will fu with PCP this week.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1130931&WAYBACKHISTORY=ON


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