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This is VAERS ID 1185306

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1185306
VAERS Form:2
Age:21.0
Sex:Male
Location:Tennessee
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, Immediate post-injection reaction, Vital signs measurement

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:
Other Medications: None
Current Illness: No
Preexisting Conditions: No
Allergies: NKDA
Diagnostic Lab Data: 136/92, O2 sat 99%, HR 76 138/80, O2 sat 98%, HR 88 at discharge
CDC 'Split Type':

Write-up: Immediate brief episode of syncope without hitting head or injury. Monitored for 30 minutes with full recovery.


Changed on 5/7/2021

VAERS ID: 1185306 Before After
VAERS Form:2
Age:21.0
Sex:Male
Location:Tennessee
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, Immediate post-injection reaction, Vital signs measurement

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:
Other Medications: None
Current Illness: No
Preexisting Conditions: No
Allergies: NKDA NKDA
Diagnostic Lab Data: 136/92, O2 sat 99%, HR 76 138/80, O2 sat 98%, HR 88 at discharge
CDC 'Split Type':

Write-up: Immediate brief episode of syncope without hitting head or injury. Monitored for 30 minutes with full recovery.


Changed on 5/14/2021

VAERS ID: 1185306 Before After
VAERS Form:2
Age:21.0
Sex:Male
Location:Tennessee
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, Immediate post-injection reaction, Vital signs measurement

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:
Other Medications: None
Current Illness: No
Preexisting Conditions: No
Allergies: NKDA NKDA
Diagnostic Lab Data: 136/92, O2 sat 99%, HR 76 138/80, O2 sat 98%, HR 88 at discharge
CDC 'Split Type':

Write-up: Immediate brief episode of syncope without hitting head or injury. Monitored for 30 minutes with full recovery.

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