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This is VAERS ID 1331147

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1331147
VAERS Form:2
Age:31.0
Sex:Male
Location:Illinois
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 043A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Disorientation, Dizziness, Loss of consciousness, Muscle twitching

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: Unknown
Current Illness: N?A
Preexisting Conditions: N/A
Allergies: NKDA
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Patient started feeling lightheaded about 2- 3 mins of vaccine administration. Patient moved from the chair to the floor because he felt like he was going to pass out. Patient passed out for about 30 seconds, slight twitching during episode and then came through. He was a bit disoriented but alert, we had him stick around until his wife came and picked him up.

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