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From the 4/30/2021 release of VAERS data:

This is VAERS ID 1130931



Case Details

VAERS ID: 1130931 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-24
Onset:2021-03-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 RA / IM

Administered by: Other       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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: Hx fainting, cardiac murmur
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt. reported feeling light headed, after sitting experienced a syncopal episode. BP 98/45 p 75. Pt. was revivied after about 35 seconds and stated feeling better. BP 112/72, p 76. Pt. stated has hx of syncope. Pt and family refused to be transferred via squad. Pt. states he will fu with PCP this week.


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