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

This is VAERS ID 1180658



Case Details

VAERS ID: 1180658 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Unknown  
Location: Washington  
Vaccinated:2021-04-01
Onset:2021-04-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Hyperhidrosis, Pallor, Unresponsive to stimuli
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: unknown
Diagnostic Lab Data: code team called, patient woke up and started responding right before epi injection administration Transferred to ED
CDC Split Type:

Write-up: unresponsive, pale, diaphoretic, SBP 80s HR 50s


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1180658

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