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This is VAERS ID 1375969

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1375969
VAERS Form:2
Age:38.0
Sex:Female
Location:Wisconsin
Vaccinated:2021-06-03
Onset:2021-06-03
Submitted:0000-00-00
Entered:2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 6 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Loss of consciousness, Syncope, Unresponsive to stimuli

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: UNKNOWN
Current Illness: PATIENT HAS PREVIOUSLY EXPERIENCED POTS SYNDROM/CONDITION - PAROXYSYMAL ORTHOSTATIC TACHYCARDIA
Preexisting Conditions: UNKNOWN - NO HISTORY OF ANY NEUROLOGICAL CONDITION - NOT ILL ON DAY OF VACCINATION - NO HISTORY OF ADVERSE REACTIONS TO PREVIOUS VACCINATIONS
Allergies: NONE
Diagnostic Lab Data: NONE -
CDC 'Split Type':

Write-up: Patient received vaccine with no apparent issue - sat in our waiting area per request for anticipated 15 minute + stay - Approximately 5 minutes after vaccination patient began to experience dizziness - elevated legs with chair with patient in sitting position - a minute later patient became unresponsive and appeared to have fainted/lost consciousness. Activated 911 system with local fire department and with patient not responsive - lifted patient from chair and placed on floor with cushion for head and elevated legs slightly - the patient had a pulse and was breathing the entire time and when able to communicate informed us she has a POTS condition - at this time EMT services arrived and stayed with patient for approximately 15 - 20 minutes talking the entire time - no transport to hospital - no drugs administered - patient may have followed up with walk-in/ER services but did not require transport and was released by EMT services

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