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This is VAERS ID 1230445

History of Changes from the VAERS Wayback Machine

First Appeared on 4/23/2021

VAERS ID: 1230445
VAERS Form:2
Age:19.0
Sex:Female
Location:Massachusetts
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 203A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Fall, Head injury

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: 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.


Changed on 5/7/2021

VAERS ID: 1230445 Before After
VAERS Form:2
Age:19.0
Sex:Female
Location:Massachusetts
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 203A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Fall, Head injury

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: unknown
Current Illness: no conditions listed on VARS
Preexisting Conditions: non listed on VARS
Allergies: no allergies listed on VARS 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.


Changed on 5/14/2021

VAERS ID: 1230445 Before After
VAERS Form:2
Age:19.0
Sex:Female
Location:Massachusetts
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 203A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Fall, Head injury

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: unknown
Current Illness: no conditions listed on VARS
Preexisting Conditions: non listed on VARS
Allergies: no allergies listed on VARS 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.

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


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