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This is VAERS ID 1330800

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1330800
VAERS Form:2
Age:59.0
Sex:Male
Location:Unknown
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 1808986 / 1 LA / IM

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

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Patient experienced syncope less than 5 minutes after receiving the Janssen COVID-19 shot. We alerted store management and called 911. He regained consciousness after about 15 seconds or so. We laid him on the floor and got cold, wet paper towels to hold on his head. He felts weak but was alert. EMS arrived and checked his vitals. His vitals were ok. He refused to go with EMS when he was asked. We called his wife and she came and picked him up.

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