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This is VAERS ID 1371780

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371780
VAERS Form:2
Age:18.0
Sex:Male
Location:Unknown
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 202A21A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Electrocardiogram normal, Syncope, Tension, Skin laceration, Craniocerebral injury

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Denies
Current Illness: /none
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC 'Split Type':

Write-up: While in observation after vaccine was given, 18 y/o male had a tension of body and fainted out of chair from sitting position. Head did hit the concreate floor. Male immediately jumped up once he hit the floor. Syncopal event occurred. HE was brought back into treatment area and placed on EKG along with vitals. Normal sinus rhythm, BP and HR stable. Small laceration to right side of temporal lobe about 1cm long, minimal depth, no stiches required, bleeding stopped immediately and ice pack placed. Neurological intact, pupils equal and reacted to light. AAOX4, No nausea, vomiting or dizziness. Male is stable condition with brother. Advised to seek further eval with x-ray of skull for precaution. He was in agreement and understood.

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