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This is VAERS ID 1316561

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1316561
VAERS Form:2
Age:39.0
Sex:Female
Location:Massachusetts
Vaccinated:2021-05-04
Onset:2021-05-04
Submitted:0000-00-00
Entered:2021-05-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Syncope, Unresponsive to stimuli, Medical counselling

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Fainting / Unresponsive-Mild, Additional Details: Counseled patient. She said she ate very little before the vaccination. She fainted for a couple minutes and had to lie down. She informed pharmacy staff. I went over to her and offered her a bottle of water and stayed with her for approximately 10 minutes until she felt fine. She said after a couple minutes and drinking some water she felt fine. She stayed sitting in the vaccination/observation area for 10 more minutes. She was at the store for approximately 45 mins and waited 30 min after shot

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