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

This is VAERS ID 1229158



Case Details

VAERS ID: 1229158 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-11
Onset:2021-04-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Head injury, Skin laceration, Syncope, Traumatic haemorrhage
SMQs:, Torsade de pointes/QT prolongation (broad), Haemorrhage terms (excl laboratory terms) (narrow), Arrhythmia related investigations, signs and symptoms (broad), Accidents and injuries (narrow), Hostility/aggression (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: SVT as a teen
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: a number of minutes after receiving the vaccine, patient fainted while seated, fell backwards in his chair, and hit his head on the floor. as a result of the fall, the back of his head was cut. he remained on the floor and gauze was held against the cut to slow/stop the bleeding until the ambulance service arrived. Patient was taken to the hospital for treatment of the cut. Patient is currently in good health.


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