Your Health. Your Family. Your Choice.
|History of Changes from the VAERS Wayback Machine|
|Vaccination / Manufacturer||Lot / Dose||Site / Route|
|COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN||203A21A / 1||LA / SYR|
Administered by: Pharmacy Purchased by: ??
Symptoms: Dizziness, Feeling hot, Hyperhidrosis, Loss of consciousness, Malaise, Tremor, Musculoskeletal stiffness
Life Threatening? No
Birth Defect? No
Permanent Disability? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Other Medications: unknown
Current Illness: none at time of vaccination and unknown up to one month prior
Preexisting Conditions: none
Allergies: no known allergies
Diagnostic Lab Data:
CDC 'Split Type':
Write-up: Patient received vaccine dose at 4:43pm. At approximately 4:48pm, she stood up to tell staff that she was feeling ok and wanted to pick up an item in the store. A staff member saw that she looked unwell and asked if she was ok and she said no. She passed out at that moment. She was unconscious for approximately 5-10 seconds. Her body became stiff and her shoulder/arm trembled during that time frame of being unconscious. She refused an ambulance. She remained in the pharmacy for 30 minutes until she no longer felt light-headed. During the 30 minutes, she felt light-headed, hot and was sweating. She said she felt fine after the 30 minute wait.
Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166