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This is VAERS ID 1371651

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371651
VAERS Form:2
Age:21.0
Sex:Male
Location:North Carolina
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 2055A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Blood glucose normal, Condition aggravated, Electrocardiogram normal, 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: Yes, patient reported fainting during childhood vaccine
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: No Known Allergies
Diagnostic Lab Data: N/A
CDC 'Split Type':

Write-up: Patient had two syncope events after vaccine administration lasting approximately 5-10 seconds. He was monitored continuously. EMS were called and checked blood pressure, blood glucose, and did an EKG -all values were normal. Additionally, patient remained being monitored for 30 minutes until picked up by family member. Patient recovered from adverse events.

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