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This is VAERS ID 1371238

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371238
VAERS Form:2
Age:27.0
Sex:Male
Location:New Jersey
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 203A21A / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Altered state of consciousness, Dizziness, Fall, Immediate post-injection reaction

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)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: No other medications.
Current Illness: No other illnesses.
Preexisting Conditions: No chronic health conditions.
Allergies: No known allergies.
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Approximately 1 minute after administering vaccine, patient asked for water with complaints of lightheadedness. As he walked up to pharmacy door for water, he collapsed to the ground. He went in and out of consciousness while laying on the ground for about ten minutes. He had no other complaints other than lightheadedness. He did not eat any food today. He said in the past he had fainted after getting a numbing injection for a dental procedure and believes it may be a similar reaction. The paramedics were called and evaluated him. His blood pressure and HR were within normal limits. He refused to be taken to the hospital for further evaluation.

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