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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1081167

Case Details

VAERS ID: 1081167 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Male  
Location: Virginia  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood creatine phosphokinase, Blood magnesium, Blood thyroid stimulating hormone, Chest X-ray, Computerised tomogram head, Echocardiogram, Electrocardiogram, Full blood count, Hepatitis C antibody, Influenza A virus test, Influenza B virus test, Loss of consciousness, Metabolic function test, Respiratory syncytial virus test, SARS-CoV-2 test, Troponin, Troponin I, Unresponsive to stimuli
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Men''s One A Day Multivitamin, Metoprolol Tartrate 25 MG 2x a day, Ezetimibe 10 MG 1 a day around 8pm, Bayer Aspirin Low Dose 81 MG 1 a day, Atorvastatin Calcium 80MG 1 a day around 8pm.
Current Illness: N/A
Preexisting Conditions: Heart Disease
Allergies: N/A
Diagnostic Lab Data: 3/7/2021 Troponin Stat (ITRP) Basic Metabolic Panel (BMP) CBC with Auto Diff (CBCD) CK (CK) Hepatitis C Custom Reflex (HCCR) Magnesium (MG) Sars COV 2, INFLU. A?B, RSV PCR (COFRP) Troponini I (TROP) Performed 2 times TSH (TSH) CT Head/Brain WO Cont EKG (12-Lead) XR Chest 1 VW ECHO
CDC Split Type:

Write-up: Woke up around 5:30AM having to go to the bathroom. Went to Flush the toilet and passed out on the floor. My wife found me unresponsive but breathing on the floor. My wife called 911 and was at the hospital around 6:15AM.

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