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This is VAERS ID 1213180

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1213180
VAERS Form:2
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Loss of consciousness, Pneumothorax traumatic, Rib fracture, Laboratory test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Patient visit to ED, no chart notes acquired by myself.
CDC 'Split Type':

Write-up: Possible vasovagal syncope. She "blacked out" in bathroom and fell. Broke ribs and had pneumothorax due to the fall. Had a couple other episodes of "blacking out" in the next 48 hours. Went to E.D. for injury. Work up was done, she mentioned she had just had the vaccine a few days prior and no VAERS was submitted by ED, they dismissed it. According to patient workup was done to detect embolism or hemorrhage and none was found.


Changed on 5/7/2021

VAERS ID: 1213180 Before After
VAERS Form:2
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Loss of consciousness, Pneumothorax traumatic, Rib fracture, Laboratory test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Patient visit to ED, no chart notes acquired by myself.
CDC 'Split Type':

Write-up: Possible vasovagal syncope. She "blacked out" in bathroom and fell. Broke ribs and had pneumothorax due to the fall. Had a couple other episodes of "blacking out" in the next 48 hours. Went to E.D. for injury. Work up was done, she mentioned she had just had the vaccine a few days prior and no VAERS was submitted by ED, they dismissed it. According to patient workup was done to detect embolism or hemorrhage and none was found.


Changed on 5/14/2021

VAERS ID: 1213180 Before After
VAERS Form:2
Age:
Sex:Unknown
Location:Unknown
Vaccinated:0000-00-00
Onset:0000-00-00
Submitted:0000-00-00
Entered:2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

Administered by: Unknown      Purchased by: ??
Symptoms: Loss of consciousness, Pneumothorax traumatic, Rib fracture, Laboratory test

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Patient visit to ED, no chart notes acquired by myself.
CDC 'Split Type':

Write-up: Possible vasovagal syncope. She "blacked out" in bathroom and fell. Broke ribs and had pneumothorax due to the fall. Had a couple other episodes of "blacking out" in the next 48 hours. Went to E.D. for injury. Work up was done, she mentioned she had just had the vaccine a few days prior and no VAERS was submitted by ED, they dismissed it. According to patient workup was done to detect embolism or hemorrhage and none was found.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1213180&WAYBACKHISTORY=ON

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