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This is VAERS ID 1185189

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1185189
VAERS Form:2
Age:44.0
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: Pharmacy      Purchased by: ??
Symptoms: Nervousness, 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: pt did not state
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt fainted, the pt was sitting in the chair and fell off. the pt immediately woke up after falling. the pt said he was ok. he said he just wanted to lie down. he did so for about 10 minutes and then sat back up in the chair. we said he was feeling ok. he said he fainted because he was nervous. he did not think that it was because of the covid shot.


Changed on 5/7/2021

VAERS ID: 1185189 Before After
VAERS Form:2
Age:44.0
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: Pharmacy      Purchased by: ??
Symptoms: Nervousness, 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: pt did not state
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt fainted, the pt was sitting in the chair and fell off. the pt immediately woke up after falling. the pt said he was ok. he said he just wanted to lie down. he did so for about 10 minutes and then sat back up in the chair. we said he was feeling ok. he said he fainted because he was nervous. he did not think that it was because of the covid shot.


Changed on 5/14/2021

VAERS ID: 1185189 Before After
VAERS Form:2
Age:44.0
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: Pharmacy      Purchased by: ??
Symptoms: Nervousness, 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: pt did not state
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: pt fainted, the pt was sitting in the chair and fell off. the pt immediately woke up after falling. the pt said he was ok. he said he just wanted to lie down. he did so for about 10 minutes and then sat back up in the chair. we said he was feeling ok. he said he fainted because he was nervous. he did not think that it was because of the covid shot.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1185189&WAYBACKHISTORY=ON


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