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This is VAERS ID 1327503

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1327503
VAERS Form:2
Age:31.0
Sex:Male
Location:Ohio
Vaccinated:2021-05-18
Onset:2021-05-18
Submitted:0000-00-00
Entered:2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Cold sweat, Loss of consciousness

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: Blood pressure (5/18): 86/58 Pulse (5/18): 48
CDC 'Split Type':

Write-up: Approximately 10 minutes after receiving the Janssen vaccine the patient walked up to the pharmacy counter and asked a technician if it was normal to feel clammy after the vaccine. Immediately after the patient passed out.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1327503&WAYBACKHISTORY=ON


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