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

This is VAERS ID 1186046



Case Details

VAERS ID: 1186046 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Unknown  
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 2002A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Contusion, Dizziness
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Anticholinergic syndrome (broad), Accidents and injuries (narrow), Vestibular disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: A + O x 4 Pain 1/10 10:00 BP 100/5 HR 70 O2 97% 10:05 BP 121/76 HR 79 O2 100%
CDC Split Type:

Write-up: Pt sat for 15 mins, got up started to walk felt dizzy and fell down, hit head on wall. bruise on head above left eye 1" x1/4" Pt stated this is a typical reaction to blood draw


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