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This is VAERS ID 1371718

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371718
VAERS Form:2
Age:38.0
Sex:Male
Location:Arkansas
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: Fall, Head injury, Loss of consciousness

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: syncope
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data: none
CDC 'Split Type':

Write-up: Patient received a dose of the Jassen covid vaccine and was sitting in the waiting room for his 15 minutes of observation. After about 10 minutes he passed out and fell out of his chair bumping his head on the way down.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1371718&WAYBACKHISTORY=ON


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