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This is VAERS ID 1376406

History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1376406
VAERS Form:2
Age:28.0
Sex:Male
Location:Nevada
Vaccinated:2021-06-04
Onset:2021-06-04
Submitted:0000-00-00
Entered:2021-06-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Chills, Dizziness, Nausea, Paraesthesia, Vomiting

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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Chills-Medium, Systemic: Dizziness / Lightheadness-Medium, Systemic: Nausea-Medium, Systemic: Vomiting-Medium, Additional Details: After about 5 minutes after patient recieved COVID shot, he wasn''t normal. He said he had lightheadness and chills and tingling. A few minutes later he went to the bathroom to vomit. Paramedic called because patient didn''t seem well and patient said he needed medical attention. Paramedic came about 5-8 minutes. Patient left a few minutes after paramedic left.

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