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This is VAERS ID 1375938

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1375938
VAERS Form:2
Age:19.0
Sex:Male
Location:Oregon
Vaccinated:2021-06-01
Onset:2021-06-01
Submitted:0000-00-00
Entered:2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Public      Purchased by: ??
Symptoms: Syncope, Immediate post-injection reaction

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
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: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: No known allergies
Diagnostic Lab Data: Unknown
CDC 'Split Type':

Write-up: Client immediately fainted upon receiving the vaccination in his right deltoid.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1375938&WAYBACKHISTORY=ON


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