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This is VAERS ID 1184993

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1184993
VAERS Form:2
Age:22.0
Sex:Male
Location:Georgia
Vaccinated:2021-04-09
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: School      Purchased by: ??
Symptoms: Syncope

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)? No
Hospitalized? No
Previous Vaccinations: near syncope with flu shot brand unknown
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: NKDA
Diagnostic Lab Data: BP 122/78, O2 sat 98%, HR 60
CDC 'Split Type':

Write-up: Immediate brief < 1 minute syncopal episode without head injury or injury. Fully recovered after 30 minute observation.


Changed on 5/7/2021

VAERS ID: 1184993 Before After
VAERS Form:2
Age:22.0
Sex:Male
Location:Georgia
Vaccinated:2021-04-09
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: School      Purchased by: ??
Symptoms: Syncope

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)? No
Hospitalized? No
Previous Vaccinations: near syncope with flu shot brand unknown
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: NKDA NKDA
Diagnostic Lab Data: BP 122/78, O2 sat 98%, HR 60
CDC 'Split Type':

Write-up: Immediate brief < 1 minute syncopal episode without head injury or injury. Fully recovered after 30 minute observation.


Changed on 5/14/2021

VAERS ID: 1184993 Before After
VAERS Form:2
Age:22.0
Sex:Male
Location:Georgia
Vaccinated:2021-04-09
Onset:2021-04-09
Submitted:0000-00-00
Entered:2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: School      Purchased by: ??
Symptoms: Syncope

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)? No
Hospitalized? No
Previous Vaccinations: near syncope with flu shot brand unknown
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: NKDA NKDA
Diagnostic Lab Data: BP 122/78, O2 sat 98%, HR 60
CDC 'Split Type':

Write-up: Immediate brief < 1 minute syncopal episode without head injury or injury. Fully recovered after 30 minute observation.

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