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

This is VAERS ID 1191417



Case Details

VAERS ID: 1191417 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-03
Onset:2021-04-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Gallbladder disorder, Myocardial infarction
SMQs:, Myocardial infarction (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Gallbladder related disorders (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies: Penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Approximately 15 minutes after administering the vaccine, the patient reported feeling dizzy. I checked her blood pressure and pulse and both were normal. On 4/8/21, an email from our manager of Human Resources stated that the patient was in the hospital since 4/7/21. It also stated she had a heart attacked and issues with her gallbladder.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1191417

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