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This is VAERS ID 1470395

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1470395
VAERS Form:2
Age:33.0
Sex:Female
Location:New York
Vaccinated:2021-07-13
Onset:2021-07-13
Submitted:0000-00-00
Entered:2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Loss of consciousness, Syncope, Gaze palsy, Foaming at mouth

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: Unknown
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Blood pressure 100/58
CDC 'Split Type':

Write-up: Patient lost consciousness for approximately 30 seconds immediately after receiving the vaccination. Her eyes and head rolled back, and there was a small amount of foam coming from the mouth. The patient did not enter anaphylaxis or stop breathing at any point. A pharmacy technician called 911 while the pharmacist moved the patient to the ground to lay down and monitor for further reaction. The patient was provided with food and water. EMS arrived on the scene approximately 10 minutes later. They took the patient''s pulse and blood pressure, which was slightly low (100/58 - I believe). The paramedics determined that the patient experienced syncope and there was no need for further evaluation at the facility. The patient remained in the pharmacy for about an hour until she felt strong enough to go home.

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