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This is VAERS ID 1172925

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1172925
VAERS Form:2
Age:51.0
Sex:Female
Location:California
Vaccinated:2021-04-06
Onset:2021-04-06
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Loss of consciousness, 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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril
Current Illness: Hypertension
Preexisting Conditions: Chronic
Allergies: No
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient fainted after receiving Janssen Covid 19 vaccine. Patient was sitting down after the vaccine but fainted about 5 minutes after injection. Patient loss consciousness for a minute and woke up after husband was calling her name. EMT arrived and escorted patient to hospital.


Changed on 5/7/2021

VAERS ID: 1172925 Before After
VAERS Form:2
Age:51.0
Sex:Female
Location:California
Vaccinated:2021-04-06
Onset:2021-04-06
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Loss of consciousness, 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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril
Current Illness: Hypertension
Preexisting Conditions: Chronic
Allergies: No No
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient fainted after receiving Janssen Covid 19 vaccine. Patient was sitting down after the vaccine but fainted about 5 minutes after injection. Patient loss consciousness for a minute and woke up after husband was calling her name. EMT arrived and escorted patient to hospital.


Changed on 5/14/2021

VAERS ID: 1172925 Before After
VAERS Form:2
Age:51.0
Sex:Female
Location:California
Vaccinated:2021-04-06
Onset:2021-04-06
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Loss of consciousness, 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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril
Current Illness: Hypertension
Preexisting Conditions: Chronic
Allergies: No No
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient fainted after receiving Janssen Covid 19 vaccine. Patient was sitting down after the vaccine but fainted about 5 minutes after injection. Patient loss consciousness for a minute and woke up after husband was calling her name. EMT arrived and escorted patient to hospital.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1172925&WAYBACKHISTORY=ON

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