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

This is VAERS ID 1134845



Case Details

VAERS ID: 1134845 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Tennessee  
Vaccinated:2021-03-25
Onset:2021-03-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Erythema, Fall, Feeling hot, Headache, Hyperhidrosis, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: None
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received vaccine while seated and had no problems. She stood up and walked several feet to the observation seating area and had a seat. A few minutes later she fainted and fell out of the chair onto the floor. We helped her up to a sitting position and gave her a bottle of water and an ice pack. The right side of her forehead appeared red from apparent hit on the floor when she fainted. We had her wait on the floor for about 30 minutes to ensure she remained conscious. Patient reported an ache on her forehead at site of hit. She was also sweating and reported feeling hot. Patient had a partner with her who agreed to escort her to an urgent care clinic in the same building as the pharmacy. Store manager in charge took the patient to the urgent care clinic by wheelchair to be examined.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1134845


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