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

This is VAERS ID 1185306



Case Details

VAERS ID: 1185306 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: Tennessee  
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: Immediate post-injection reaction, Syncope, Vital signs measurement
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Hypersensitivity (narrow), 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:
Other Medications: None
Current Illness: No
Preexisting Conditions: No
Allergies: NKDA
Diagnostic Lab Data: 136/92, O2 sat 99%, HR 76 138/80, O2 sat 98%, HR 88 at discharge
CDC Split Type:

Write-up: Immediate brief episode of syncope without hitting head or injury. Monitored for 30 minutes with full recovery.


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