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This is VAERS ID 1173292

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1173292
VAERS Form:2
Age:37.0
Sex:Male
Location:Connecticut
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: Discomfort, Fall, Loss of consciousness, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: antianxiety medication
Current Illness: mild hemophilia
Preexisting Conditions: mild hemophilia
Allergies: no know allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient got his vaccine, put his shirt back on and buttoned it up and asked if it should be sore already. I told him, yes the shot may cause some discomfort after injection and he was standing at this point. He was about to say something and he fell backwards and hit a mobile laptop cart and the wall. The patient went unconscious not talking but breathing was given an epipen and 911 called vaccine given a few minutes before 12:30 and 911 called at 12:29. He regained consciousness fairly quickly and was assessed by the pharmacist and then EMT and transported to the hospital for monitoring.


Changed on 5/7/2021

VAERS ID: 1173292 Before After
VAERS Form:2
Age:37.0
Sex:Male
Location:Connecticut
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: Discomfort, Fall, Loss of consciousness, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: antianxiety medication
Current Illness: mild hemophilia
Preexisting Conditions: mild hemophilia
Allergies: no know allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient got his vaccine, put his shirt back on and buttoned it up and asked if it should be sore already. I told him, yes the shot may cause some discomfort after injection and he was standing at this point. He was about to say something and he fell backwards and hit a mobile laptop cart and the wall. The patient went unconscious not talking but breathing was given an epipen and 911 called vaccine given a few minutes before 12:30 and 911 called at 12:29. He regained consciousness fairly quickly and was assessed by the pharmacist and then EMT and transported to the hospital for monitoring.


Changed on 5/14/2021

VAERS ID: 1173292 Before After
VAERS Form:2
Age:37.0
Sex:Male
Location:Connecticut
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: Discomfort, Fall, Loss of consciousness, Pain in extremity

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: antianxiety medication
Current Illness: mild hemophilia
Preexisting Conditions: mild hemophilia
Allergies: no know allergies allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: patient got his vaccine, put his shirt back on and buttoned it up and asked if it should be sore already. I told him, yes the shot may cause some discomfort after injection and he was standing at this point. He was about to say something and he fell backwards and hit a mobile laptop cart and the wall. The patient went unconscious not talking but breathing was given an epipen and 911 called vaccine given a few minutes before 12:30 and 911 called at 12:29. He regained consciousness fairly quickly and was assessed by the pharmacist and then EMT and transported to the hospital for monitoring.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1173292&WAYBACKHISTORY=ON

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