National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 6/4/2021 release of VAERS data:

This is VAERS ID 1230445



Case Details

VAERS ID: 1230445 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Female  
Location: Massachusetts  
Vaccinated:2021-04-11
Onset:2021-04-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Head injury
SMQs:, Accidents and injuries (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: no conditions listed on VARS
Preexisting Conditions: non listed on VARS
Allergies: no allergies listed on VARS
Diagnostic Lab Data: none
CDC Split Type:

Write-up: Patient fell from chair and hit head on table in waiting area approx. 5 minutes after receiving vaccine. Resulting from syncope event. Patient stated she has anxiety and is nervous when receiving vaccines. She had her boyfriend in the car and he came in and waited with her for approx. 20 to 30 more minutes. Patient had a small egg on forehead from hitting table and was given an ice bag and water to aid with symptoms. Patient stated she was trying to "breath through it". May have over breathed and resulted in too much CO2. Patient had no other episodes or symptoms following fainting. Patient was contacted and checked on that evening and the next morning, she stated she is feeling okay.


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1230445


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166