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From the 5/7/2021 release of VAERS data:

This is VAERS ID 1131634



Case Details

VAERS ID: 1131634 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Male  
Location: Arizona  
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 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Loss of consciousness, Urinary incontinence
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), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Allergies to fluconazole and clotrimazole
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received COVID vaccination and was waiting his 15 minutes in the waiting room, a few minutes after injection, his GF called me over because the patient passed out. As I approach, patient was coming to as he was peeing himself. Patient reported that he felt lightheaded and then did not realize what happened. Gave patient some water and took his blood pressure. His DBP was a little low around 49. Had the patient sit there for another 15 minutes and took blood pressure again and it was 104/60.


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