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This is VAERS ID 1371825

History of Changes from the VAERS Wayback Machine

First Appeared on 6/4/2021

VAERS ID: 1371825
VAERS Form:2
Age:21.0
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 205A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Loss of consciousness, Pallor

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

Write-up: The patient recieved the janssen covid vaccine at about 2:35pm. Patient passed out by his chair. It was about a few minutes after getting the janssen covid vaccine. We called 911. I went to assist him and was alert. He sat on the floor and I checked his pulse. He was pale. I offered him water which he drank after about 5 minutes. The EMT''s arrived after a few minutes and checked him out. Took his vitals and looked him over. The patient left after 20 minutes.

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