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

This is VAERS ID 1276383



Case Details

VAERS ID: 1276383 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-04-11
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Fatigue, Heart rate, Heart rate decreased, Heart rate increased, Hot flush, Loss of consciousness
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (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: Penicillin allergy; Seasonal allergy
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210412; Test Name: Heart rate; Result Unstructured Data: 149; Test Date: 20210412; Test Name: Heart rate; Result Unstructured Data: 43
CDC Split Type: USJNJFOC20210424060

Write-up: PASSED OUT (FAINTED); HEART RATE OF 43; HEART RATE AS HIGH AS 149; TIREDNESS; HOT FLASHES; CHILLS; This spontaneous report received from a patient concerned a 59 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included seasonal allergies, and penicillin allergy. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, and batch number: 205A21A expiry: UNKNOWN) dose was not reported, 1 total dose administered on 11-APR-2021 on left deltoid for prophylactic vaccination. No concomitant medications were reported. On 11-APR-2021, the patient experienced hot flashes and chills which would come and come. She did not had temperature, but she took paracetamol (Tylenol) for her side effects. On 12-APR-2021 (within 24 hours of getting the vaccine), she passed out (fainted), which occurred once. While passed out her heart rate was 43 which she said lasted for minutes. Her heart rate was as high as 149 since she has received the vaccine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from passed out (fainted), had not recovered from hot flashes, chills, and tiredness, and the outcome of heart rate of 43 and heart rate as high as 149 was not reported. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0. 20210424060-covid-19 vaccine ad26.cov2.s -Passed out (fainted). This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


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