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This is VAERS ID 1376553

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History of Changes from the VAERS Wayback Machine

First Appeared on 6/11/2021

VAERS ID: 1376553
VAERS Form:2
Age:33.0
Sex:Female
Location:Texas
Vaccinated:2021-06-03
Onset:2021-06-03
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: Syncope, Unresponsive to stimuli, 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)? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Systemic: Fainting / Unresponsive-Mild, Systemic: Vomiting-Mild, Additional Details: Patient fainted but woke up very quick. Vomitted once the started feeling better. No signs and symptoms of allergic reaction. We called 911 and was checked on site. The 911 personales reported no issue but patient caregiver asked that patient to be checked at the ER.

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