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This is VAERS ID 1368005

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1368005
VAERS Form:2
Age:42.0
Sex:Female
Location:Maryland
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 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Syncope

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: none
Preexisting Conditions: none
Allergies: no allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient was given 0.5mL of Janssen vaccine IM into her right deltoid muscle. Post vaccine patient, fainted during the 15 minute wait period. She was promptly attended to, and did not exhibit signs of anaphylaxis. EMS came to assess patient even though she felt "completely normal" after she fainted.

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