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This is VAERS ID 1229158

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1229158
VAERS Form:2
Age:21.0
Sex:Male
Location:New York
Vaccinated:2021-04-11
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / N/A RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Fall, Head injury, Syncope, Traumatic haemorrhage, Skin laceration

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: SVT as a teen
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: a number of minutes after receiving the vaccine, patient fainted while seated, fell backwards in his chair, and hit his head on the floor. as a result of the fall, the back of his head was cut. he remained on the floor and gauze was held against the cut to slow/stop the bleeding until the ambulance service arrived. Patient was taken to the hospital for treatment of the cut. Patient is currently in good health.


Changed on 5/7/2021

VAERS ID: 1229158 Before After
VAERS Form:2
Age:21.0
Sex:Male
Location:New York
Vaccinated:2021-04-11
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / N/A RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Fall, Head injury, Syncope, Traumatic haemorrhage, Skin laceration

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: SVT as a teen
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: a number of minutes after receiving the vaccine, patient fainted while seated, fell backwards in his chair, and hit his head on the floor. as a result of the fall, the back of his head was cut. he remained on the floor and gauze was held against the cut to slow/stop the bleeding until the ambulance service arrived. Patient was taken to the hospital for treatment of the cut. Patient is currently in good health.


Changed on 5/14/2021

VAERS ID: 1229158 Before After
VAERS Form:2
Age:21.0
Sex:Male
Location:New York
Vaccinated:2021-04-11
Onset:2021-04-11
Submitted:0000-00-00
Entered:2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / N/A RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Fall, Head injury, Syncope, Traumatic haemorrhage, Skin laceration

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: SVT as a teen
Allergies: none none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: a number of minutes after receiving the vaccine, patient fainted while seated, fell backwards in his chair, and hit his head on the floor. as a result of the fall, the back of his head was cut. he remained on the floor and gauze was held against the cut to slow/stop the bleeding until the ambulance service arrived. Patient was taken to the hospital for treatment of the cut. Patient is currently in good health.

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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1229158&WAYBACKHISTORY=ON


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