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This is VAERS ID 1137019

History of Changes from the VAERS Wayback Machine

First Appeared on 4/1/2021

VAERS ID: 1137019
VAERS Form:2
Age:22.0
Sex:Male
Location:New York
Vaccinated:2021-03-26
Onset:2021-03-26
Submitted:0000-00-00
Entered:2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Loss of consciousness, Seizure, Tonic clonic movements

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: Keppra
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient passed out and began seizing within 5 minutes of vaccine administration sitting down on chair. Tonic, clonic motions for 5 seconds. No foaming at the mouth. Patient was taken off chair, held on the ground until seizure ended. Patient gained consciousness after a minute. Given water, snacks, air and EMS was called. EMS assessed situation, and allowed patient''s girlfriend to pick him up from site and drive back home.


Changed on 5/7/2021

VAERS ID: 1137019 Before After
VAERS Form:2
Age:22.0
Sex:Male
Location:New York
Vaccinated:2021-03-26
Onset:2021-03-26
Submitted:0000-00-00
Entered:2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Work      Purchased by: ??
Symptoms: Loss of consciousness, Seizure, Tonic clonic movements

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: Keppra
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient passed out and began seizing within 5 minutes of vaccine administration sitting down on chair. Tonic, clonic motions for 5 seconds. No foaming at the mouth. Patient was taken off chair, held on the ground until seizure ended. Patient gained consciousness after a minute. Given water, snacks, air and EMS was called. EMS assessed situation, and allowed patient''s girlfriend to pick him up from site and drive back home.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1137019&WAYBACKHISTORY=ON


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