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

This is VAERS ID 1083182



Case Details

VAERS ID: 1083182 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Georgia  
Vaccinated:2021-03-08
Onset:2021-03-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 7+ LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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? No
Previous Vaccinations:
Other Medications: Patient did not state any medication history
Current Illness: none
Preexisting Conditions: none
Allergies: NKA
Diagnostic Lab Data: monitored vitals in pharmacy until EMT arrived-3/8/2021
CDC Split Type:

Write-up: patient stated she was fine after vaccine, then after a few minutes she stated she felt dizzy. before pharmacist could get back around counter to patient, she fainted and slid out of her chair. patient was alert moments after landing on the floor. patient was laid out on floor and vitals monitored. once vitals returned to normal and patient felt better, she was given water and a banana. EMT arrived and evaluated patient. patient was taken to hospital per EMT suggestion. time frame: 17:26-17:52


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