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This is VAERS ID 1181746

History of Changes from the VAERS Wayback Machine

First Appeared on 4/16/2021

VAERS ID: 1181746
VAERS Form:2
Age:34.0
Sex:Male
Location:California
Vaccinated:2021-04-08
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dizziness, Electrocardiogram, Fall, Head injury, Skin laceration

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 Reported
Current Illness: None Reported
Preexisting Conditions: Asthma
Allergies: Cats, pollen, and weeds.
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Janssen dose given at 11:38am. At 11:45am Patient c/o feeling dizzy while sitting in the chair post vaccine (5 Min Jassen). Patient fell backward onto the ground hitting his head and sustaining a posterior head laceration. Vitals taken B/P 101/52 HR 58 RR 16 SPO2 100% RA..... EKG completed and fluids N/S given. Transferred out to ED


Changed on 5/7/2021

VAERS ID: 1181746 Before After
VAERS Form:2
Age:34.0
Sex:Male
Location:California
Vaccinated:2021-04-08
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dizziness, Electrocardiogram, Fall, Head injury, Skin laceration

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 Reported
Current Illness: None Reported
Preexisting Conditions: Asthma
Allergies: Cats, pollen, and weeds. weeds.
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Janssen dose given at 11:38am. At 11:45am Patient c/o feeling dizzy while sitting in the chair post vaccine (5 Min Jassen). Patient fell backward onto the ground hitting his head and sustaining a posterior head laceration. Vitals taken B/P 101/52 HR 58 RR 16 SPO2 100% RA..... EKG completed and fluids N/S given. Transferred out to ED


Changed on 5/14/2021

VAERS ID: 1181746 Before After
VAERS Form:2
Age:34.0
Sex:Male
Location:California
Vaccinated:2021-04-08
Onset:2021-04-08
Submitted:0000-00-00
Entered:2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Dizziness, Electrocardiogram, Fall, Head injury, Skin laceration

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 Reported
Current Illness: None Reported
Preexisting Conditions: Asthma
Allergies: Cats, pollen, and weeds. weeds.
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Janssen dose given at 11:38am. At 11:45am Patient c/o feeling dizzy while sitting in the chair post vaccine (5 Min Jassen). Patient fell backward onto the ground hitting his head and sustaining a posterior head laceration. Vitals taken B/P 101/52 HR 58 RR 16 SPO2 100% RA..... EKG completed and fluids N/S given. Transferred out to ED

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1181746&WAYBACKHISTORY=ON

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