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This is VAERS ID 1178073

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1178073
VAERS Form:2
Age:32.0
Sex:Male
Location:New Mexico
Vaccinated:2021-04-07
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Fall, Hypoaesthesia, Loss of consciousness, Pain in extremity

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: None
CDC 'Split Type':

Write-up: Patient recieved vaccine and was moved to observation area. Patient suddenly lost conciousness and fell from chair to the ground. Pt regained conciousness within 30 seconds. Patient was alert and orient upon regaining conciousness. Patient verbalized he was having no trouble breathing and vitals were taken. Patient vital signs were within normal ranges. Patient verbalized that his left arm hurt and fingers were numb on that side. Patient was taken to urgent care clinic and evaluated by physician. Patient signed an AMA form and was released from hospital. Patient encouraged to follow up with primary care doctor.


Changed on 5/7/2021

VAERS ID: 1178073 Before After
VAERS Form:2
Age:32.0
Sex:Male
Location:New Mexico
Vaccinated:2021-04-07
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Fall, Hypoaesthesia, Loss of consciousness, Pain in extremity

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: None
CDC 'Split Type':

Write-up: Patient recieved vaccine and was moved to observation area. Patient suddenly lost conciousness and fell from chair to the ground. Pt regained conciousness within 30 seconds. Patient was alert and orient upon regaining conciousness. Patient verbalized he was having no trouble breathing and vitals were taken. Patient vital signs were within normal ranges. Patient verbalized that his left arm hurt and fingers were numb on that side. Patient was taken to urgent care clinic and evaluated by physician. Patient signed an AMA form and was released from hospital. Patient encouraged to follow up with primary care doctor.


Changed on 5/14/2021

VAERS ID: 1178073 Before After
VAERS Form:2
Age:32.0
Sex:Male
Location:New Mexico
Vaccinated:2021-04-07
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Fall, Hypoaesthesia, Loss of consciousness, Pain in extremity

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: None
CDC 'Split Type':

Write-up: Patient recieved vaccine and was moved to observation area. Patient suddenly lost conciousness and fell from chair to the ground. Pt regained conciousness within 30 seconds. Patient was alert and orient upon regaining conciousness. Patient verbalized he was having no trouble breathing and vitals were taken. Patient vital signs were within normal ranges. Patient verbalized that his left arm hurt and fingers were numb on that side. Patient was taken to urgent care clinic and evaluated by physician. Patient signed an AMA form and was released from hospital. Patient encouraged to follow up with primary care doctor.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1178073&WAYBACKHISTORY=ON

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