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

This is VAERS ID 1185165



Case Details

VAERS ID: 1185165 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Maryland  
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: Private       Purchased by: ?
Symptoms: Dizziness, Hypotension, Nausea, Presyncope, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (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: VASOVAGEL
Other Medications: HCTZ, irbersartan
Current Illness: none known
Preexisting Conditions: HTN
Allergies: bactrim, cozaar, lisinopril
Diagnostic Lab Data: n/a BP down to 106/85
CDC Split Type:

Write-up: + lightheaded and nausea, and then syncope followed by hypotension consistent with vasovagal response.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1185165


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