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This is VAERS ID 1417624

History of Changes from the VAERS Wayback Machine

First Appeared on 6/25/2021

VAERS ID: 1417624
VAERS Form:2
Age:34.0
Sex:Male
Location:Florida
Vaccinated:2021-06-20
Onset:2021-06-20
Submitted:0000-00-00
Entered:2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Loss of consciousness

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: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: Patient passed out for about 15 seconds about 3 to 5 minutes after receiving vaccine. pharmacy staff called EMS. Patient woke up after 15 seconds and was alert. He was given a bottle of water and stated that he was okay. He refused to go to hospital. Pharmacy followed up with him the next day and patient stated that he was completely back to normal health status.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1417624&WAYBACKHISTORY=ON


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