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This is VAERS ID 1133329

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1133329
VAERS Form:2
Age:30.0
Sex:Male
Location:California
Vaccinated:2021-03-25
Onset:2021-03-25
Submitted:0000-00-00
Entered:2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Dizziness, Fall, Loss of consciousness, Skin abrasion

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:
Other Medications: n/a
Current Illness: n/a
Preexisting Conditions: n/a
Allergies: n/a
Diagnostic Lab Data: n/a
CDC 'Split Type':

Write-up: Pt began to feel lightheaded. Stood up to call nurse then lost consciousness, falling to the ground, scraping his face on the concrete. Pt had facial abrasions. Was transported to Urgent Care.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1133329&WAYBACKHISTORY=ON


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