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This is VAERS ID 1371573

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371573
VAERS Form:2
Age:25.0
Sex:Male
Location:Pennsylvania
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 207A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Pallor, 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: Fainted frequently happens after getting vaccinations according to the patients mother.
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: Patient fainted after receiving shot. He came too after 1 to 2 minutes. He was pale in the face but was back to normal after waiting for 30 minutes after the episode.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1371573&WAYBACKHISTORY=ON


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