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From the 6/4/2021 release of VAERS data:

This is VAERS ID 1184993



Case Details

VAERS ID: 1184993 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (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: near syncope with flu shot brand unknown
Other Medications: No
Current Illness: No
Preexisting Conditions: No
Allergies: NKDA
Diagnostic Lab Data: BP 122/78, O2 sat 98%, HR 60
CDC Split Type:

Write-up: Immediate brief < 1 minute syncopal episode without head injury or injury. Fully recovered after 30 minute observation.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1184993


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