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This is VAERS ID 1331491

History of Changes from the VAERS Wayback Machine

First Appeared on 5/21/2021

VAERS ID: 1331491
VAERS Form:2
Age:45.0
Sex:Male
Location:Virginia
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 202A21A / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Dizziness, Electrocardiogram, Hyperhidrosis, Loss of consciousness

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)? 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

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