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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1173387



Case Details

VAERS ID: 1173387 (history)  
Form: Version 2.0  
Age: 26.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-04-03
Onset:2021-04-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Heart rate decreased, Hypotension, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (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), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: Normal blood work
CDC Split Type:

Write-up: Passed out 18 hours after vaccine, very low heart rate and blood pressure. Called 911 for ambulance to give saline solution through IV. Was taking to the emergency room and discharged 6 hours later after receiving two bags of saline solution.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1173387

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