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This is VAERS ID 1330925

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1330925
VAERS Form:2
Age:21.0
Sex:Female
Location:Pennsylvania
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 1808978 / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: 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: not known
Current Illness: not known
Preexisting Conditions: non known
Allergies: none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Pt passed out after receiving vaccine. Patient had gone to the restroom post vaccine and passed out. Patient was given two glucose tablets and water. Rested at pharmacy for 30 minutes and was fine.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1330925&WAYBACKHISTORY=ON


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