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This is VAERS ID 1485176

History of Changes from the VAERS Wayback Machine

First Appeared on 7/23/2021

VAERS ID: 1485176
VAERS Form:2
Age:48.0
Sex:Male
Location:California
Vaccinated:2021-07-01
Onset:2021-07-01
Submitted:0000-00-00
Entered:2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Fall, 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: None listed
Current Illness:
Preexisting Conditions:
Allergies: No known drug allergies
Diagnostic Lab Data:
CDC 'Split Type':

Write-up: A few minutes after receiving the vaccine, the pharmacist was informed that the patient was falling over in our waiting area. The pharmacist got to the patient and caught him before he hit the floor. He lost consciousness for less than a minute and EMS were contacted. The patient was helped into a sitting position, given water and monitored. The patient was alert and by the time the paramedics arrived. He was assessed by them and the patient did not go to the hospital.

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