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This is VAERS ID 1779003

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First Appeared on 10/15/2021

VAERS ID: 1779003
VAERS Form:2
Age:26.0
Sex:Male
Location:Virginia
Vaccinated:2021-10-09
Onset:2021-10-09
Submitted:0000-00-00
Entered:2021-10-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822811 / 1 LA / IM

Administered by: Public      Purchased by: ??
Symptoms: Cold sweat, Condition aggravated, Dizziness, Dry skin, Loss of consciousness, Skin warm, Syncope

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
Current Illness: None
Preexisting Conditions: None. Client reports that he frequently looses consciousness following blood draws and/or injections.
Allergies: None
Diagnostic Lab Data: none.
CDC 'Split Type':

Write-up: Client reported feeling lightheaded following vaccination, then fainted. Client had LOC approx. 15-20 seconds and regained consciousness spontaneously with verbal prompts. Feet elevated. Client semi-reclined. VSS. HR 72, BP 120/64. Skin initially warm, moist. Skin dry, warm to touch within 2 minutes. Client offered and accepted sips of H2O. Cool cloth applied to back of neck. No change in VS on re-check. Client observed for 15 minutes without further incidence. Client stated, "I always faint with blood draws and other shots."

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