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This is VAERS ID 1474475

History of Changes from the VAERS Wayback Machine

First Appeared on 7/16/2021

VAERS ID: 1474475
VAERS Form:2
Age:37.0
Sex:Male
Location:California
Vaccinated:2021-07-15
Onset:2021-07-15
Submitted:0000-00-00
Entered:2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 RA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Fall, Head injury, Moaning, Nervousness, Syncope, Contusion

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: none reported
Current Illness: none reported
Preexisting Conditions: none reported
Allergies: cats/ cat hair, lactose intolerance and/or allergy
Diagnostic Lab Data: All on 07/15/2021: HR: 47 O2Sat: 97 Temperature: 97.2 F
CDC 'Split Type':

Write-up: Patient fainted momentarily and fell to the floor from seat. Patient was breathing and groaning before being flipped face-up. Patient was sat upright on the floor and was alert and awake within one minute. Mild impact to right forehead on fall with slight bruising. Suspected vasovagal syncope. ED called, but patient declined ambulance transport to hospital for further help/examination/treatment. Patient stayed at pharmacy for extended amount of time for observation and in order to calm nerves. Patient called friend/family for transport from pharmacy.

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