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This is VAERS ID 1134178

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1134178
VAERS Form:2
Age:62.0
Sex:Male
Location:California
Vaccinated:2021-03-24
Onset:2021-03-25
Submitted:0000-00-00
Entered:2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Loss of consciousness

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: Patient had previous blackout 25yrs ago/did not disclose
Other Medications: UNKNOWN
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: UNKNOWN
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Patient experienced a period of unconsciousness while waiting during the post-vaccine period of 15 minutes

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1134178&WAYBACKHISTORY=ON


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