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This is VAERS ID 1330722

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1330722
VAERS Form:2
Age:30.0
Sex:Male
Location:Tennessee
Vaccinated:2021-05-19
Onset:2021-05-19
Submitted:0000-00-00
Entered:2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Syncope

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: unknown
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: The patient experienced vasovagal syncope a few minutes following vaccine administration. Patient became alert seconds after fainting and made a full recovery.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1330722&WAYBACKHISTORY=ON


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