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This is VAERS ID 1367713

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1367713
VAERS Form:2
Age:35.0
Sex:Male
Location:Rhode Island
Vaccinated:2021-06-02
Onset:2021-06-02
Submitted:0000-00-00
Entered:2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Anxiety, Condition aggravated, Dizziness, Nervousness

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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: After giving vaccine, patient was in observation area and stated he felt light headed. He was nervous about the vaccine and feeling anxious. After speaking with him, he calmed down and stated he normally gets anxious regarding immunizations. He sat for 20 minutes and felt fine enough to go home.

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