National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

From the 7/23/2021 release of VAERS data:

This is VAERS ID 1331491



Case Details

VAERS ID: 1331491 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-05-19
Onset:2021-05-19
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Electrocardiogram, Hyperhidrosis, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: UNKNOWN
Preexisting Conditions: UNKNOWN
Allergies: NKDA
Diagnostic Lab Data: ekg
CDC Split Type:

Write-up: Janssen COVID-19 Vaccine Vaccine Lot Number: 202A21A Pt reported feeling light-headed 1-2mins after shot. unconscious for 15-20 sec. diaphoresis before passing out. 911 called. M410 transported to HEC Pt suffered no trauma or fall. 12 lead ekg performed with sinus brady and 1st degree. no daily meds, nkda. ran 4 miles today; oatmeal/granola, milk protein bar; 13:28 92/43 p 57 ; 105/71 P 42; 112/66 p 49


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1331491


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166