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This is VAERS ID 1376036

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1376036
VAERS Form:2
Age:46.0
Sex:Female
Location:Florida
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Abdominal pain upper, Disorientation, Dyspepsia, Loss of consciousness, Paraesthesia

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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient passed out, was briefly unconscious in chair. She woke up and felt disorientated. She felt tingling sensation throughout body and a burning pain in stomach.

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