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This is VAERS ID 1131634

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1131634
VAERS Form:2
Age:23.0
Sex:Male
Location:Arizona
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 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dizziness, Loss of consciousness, Urinary incontinence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Allergies to fluconazole and clotrimazole
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received COVID vaccination and was waiting his 15 minutes in the waiting room, a few minutes after injection, his GF called me over because the patient passed out. As I approach, patient was coming to as he was peeing himself. Patient reported that he felt lightheaded and then did not realize what happened. Gave patient some water and took his blood pressure. His DBP was a little low around 49. Had the patient sit there for another 15 minutes and took blood pressure again and it was 104/60.


Changed on 5/7/2021

VAERS ID: 1131634 Before After
VAERS Form:2
Age:23.0
Sex:Male
Location:Arizona
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 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dizziness, Loss of consciousness, Urinary incontinence

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Allergies to fluconazole and clotrimazole clotrimazole
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient received COVID vaccination and was waiting his 15 minutes in the waiting room, a few minutes after injection, his GF called me over because the patient passed out. As I approach, patient was coming to as he was peeing himself. Patient reported that he felt lightheaded and then did not realize what happened. Gave patient some water and took his blood pressure. His DBP was a little low around 49. Had the patient sit there for another 15 minutes and took blood pressure again and it was 104/60.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1131634&WAYBACKHISTORY=ON


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