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This is VAERS ID 1331231

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1331231
VAERS Form:2
Age:41.0
Sex:Female
Location:Florida
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 205A21A / 2 LA / 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:
Current Illness:
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient passed out approximately 10 minutes after getting her shot. She was given a bottle of water (by her spouse). EMS was called and evaluated patient. She declined further care and left with her husband once she felt better.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1331231&WAYBACKHISTORY=ON


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