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This is VAERS ID 1179758

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1179758
VAERS Form:2
Age:20.0
Sex:Female
Location:Minnesota
Vaccinated:2021-04-07
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Confusional state, Fall, Head injury, Loss of consciousness, Syncope

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NKA
Diagnostic Lab Data: Patient left hospital AMA to get CT scan
CDC 'Split Type':

Write-up: Syncopal episode appearing as a vasovagal response from receiving the vaccine. Patient fainted and fell back onto her head. Unconscious. When patient woke up she was very confused and alarmed. EMS was called and brought her to the hospital. BP, O2, resp normal


Changed on 5/7/2021

VAERS ID: 1179758 Before After
VAERS Form:2
Age:20.0
Sex:Female
Location:Minnesota
Vaccinated:2021-04-07
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Confusional state, Fall, Head injury, Loss of consciousness, Syncope

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NKA NKA
Diagnostic Lab Data: Patient left hospital AMA to get CT scan
CDC 'Split Type':

Write-up: Syncopal episode appearing as a vasovagal response from receiving the vaccine. Patient fainted and fell back onto her head. Unconscious. When patient woke up she was very confused and alarmed. EMS was called and brought her to the hospital. BP, O2, resp normal


Changed on 5/14/2021

VAERS ID: 1179758 Before After
VAERS Form:2
Age:20.0
Sex:Female
Location:Minnesota
Vaccinated:2021-04-07
Onset:2021-04-07
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Private      Purchased by: ??
Symptoms: Confusional state, Fall, Head injury, Loss of consciousness, Syncope

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: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NKA NKA
Diagnostic Lab Data: Patient left hospital AMA to get CT scan
CDC 'Split Type':

Write-up: Syncopal episode appearing as a vasovagal response from receiving the vaccine. Patient fainted and fell back onto her head. Unconscious. When patient woke up she was very confused and alarmed. EMS was called and brought her to the hospital. BP, O2, resp normal

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1179758&WAYBACKHISTORY=ON

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