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This is VAERS ID 1371207

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371207
VAERS Form:2
Age:30.0
Sex:Male
Location:Florida
Vaccinated:2021-06-03
Onset:2021-06-03
Submitted:0000-00-00
Entered:2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Other      Purchased by: ??
Symptoms: Blood glucose normal, Electrocardiogram, Fall, Presyncope, Sinus rhythm

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: nka
Diagnostic Lab Data: EKG: SINUS RHYTHM BG: 101
CDC 'Split Type':

Write-up: 9:50- Patient was sitting in chair talking to girlfriend. Per girlfriend patient''s head started to tilt back, and then he fell on his right side. Patient had a vasovagal response X 10 seconds. EMT and NP rushed to patient, immediately assessing patient, hooked him up to EKG, took vitals and blood sugar. When patient woke up he was A&OX3, patient stated he did not eat anything for the day. Vitals: 140/88, pulse 67, 100% O2, BG 101. 1000: 12 LEAD EKG was performed, patient is in SINUS RHYTHM. Another set of vitals were taken. 115/70, 91 pulse, 100% O2. Patient was given cereal bar and orange juice. 1010: Third set of vitals 123/71, pulse 74, 100% O2 1030: Patient stated he was well. Patient was able to walk to car with girlfriend. Did not request any further medical intervention.

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