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This is VAERS ID 1134552

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1134552
VAERS Form:2
Age:34.0
Sex:Male
Location:North Carolina
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 1808609 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: 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: n/a
Current Illness: none
Preexisting Conditions: none
Allergies: NKA
Diagnostic Lab Data: none available
CDC 'Split Type':

Write-up: Patient fainted after receiving vaccination.


Changed on 5/7/2021

VAERS ID: 1134552 Before After
VAERS Form:2
Age:34.0
Sex:Male
Location:North Carolina
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 1808609 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: 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: n/a
Current Illness: none
Preexisting Conditions: none
Allergies: NKA NKA
Diagnostic Lab Data: none available
CDC 'Split Type':

Write-up: Patient fainted after receiving vaccination.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1134552&WAYBACKHISTORY=ON


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