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This is VAERS ID 1750168

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History of Changes from the VAERS Wayback Machine

First Appeared on 10/1/2021

VAERS ID: 1750168
VAERS Form:2
Age:20.0
Sex:Male
Location:Texas
Vaccinated:2021-09-30
Onset:2021-09-30
Submitted:0000-00-00
Entered:2021-09-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / IM

Administered by: Pharmacy      Purchased by: ??
Symptoms: Hyperhidrosis, Loss of consciousness, Pallor, Seizure, Vomiting

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none given/listed
Current Illness: none given/listed
Preexisting Conditions: none given/listed
Allergies: none given/listed
Diagnostic Lab Data: Recommended to visit Urgent Care or Hospital to evaluate further
CDC 'Split Type':

Write-up: Patient left pharmacy under there own power, and interacted with staff fine. Uncle of patient stated in the car ride home, approx. 15min after vaccination, the patient threw up, convulsed, and loss conciseness. Our Pharmacist meet patient in the parking lot, approx. 20min after vaccination, patient was visibly sweeting and had a loss of color to face.

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1750168&WAYBACKHISTORY=ON


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