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This is VAERS ID 1365925

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1365925
VAERS Form:2
Age:22.0
Sex:Male
Location:Illinois
Vaccinated:2021-06-01
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Hyperhidrosis, Nausea, Pallor

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

Write-up: 5 minutes after vaccine administration, the patient felt light-headed, dizzy, nauseas, sweaty, and went pale.

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