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This is VAERS ID 1173387

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1173387
VAERS Form:2
Age:26.0
Sex:Male
Location:Virginia
Vaccinated:2021-04-03
Onset:2021-04-04
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Heart rate decreased, Hypotension, Loss of consciousness, Blood test

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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Normal blood work
CDC 'Split Type':

Write-up: Passed out 18 hours after vaccine, very low heart rate and blood pressure. Called 911 for ambulance to give saline solution through IV. Was taking to the emergency room and discharged 6 hours later after receiving two bags of saline solution.


Changed on 5/7/2021

VAERS ID: 1173387 Before After
VAERS Form:2
Age:26.0
Sex:Male
Location:Virginia
Vaccinated:2021-04-03
Onset:2021-04-04
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Heart rate decreased, Hypotension, Loss of consciousness, Blood test

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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: Normal blood work
CDC 'Split Type':

Write-up: Passed out 18 hours after vaccine, very low heart rate and blood pressure. Called 911 for ambulance to give saline solution through IV. Was taking to the emergency room and discharged 6 hours later after receiving two bags of saline solution.


Changed on 5/14/2021

VAERS ID: 1173387 Before After
VAERS Form:2
Age:26.0
Sex:Male
Location:Virginia
Vaccinated:2021-04-03
Onset:2021-04-04
Submitted:0000-00-00
Entered:2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Private      Purchased by: ??
Symptoms: Heart rate decreased, Hypotension, Loss of consciousness, Blood test

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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None None
Diagnostic Lab Data: Normal blood work
CDC 'Split Type':

Write-up: Passed out 18 hours after vaccine, very low heart rate and blood pressure. Called 911 for ambulance to give saline solution through IV. Was taking to the emergency room and discharged 6 hours later after receiving two bags of saline solution.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1173387&WAYBACKHISTORY=ON

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