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From the 7/23/2021 release of VAERS data:

This is VAERS ID 1328283



Case Details

VAERS ID: 1328283 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-05-18
Onset:2021-05-18
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Arrhythmia related investigations, signs and symptoms (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Syncope with what appeared as a short seizure. Patient placed flat on floor and at that time he asked "Where am I"? Respiration good, pulse good, no discoloration, no swelling , and not cold or clammy. While tending to patient a tech-in-training called 911. First responders arrived approximately 5 or 10 minutes later and followed up with the patient. He states he has never had a reaction to a flu vaccine but does not like to see the shot being given. He said that he could feel the medicine going into his muscle and it made him feel weird and doesn''t remember anything after that until he asked "Where am I"? He stayed another 10 minutes and said he felt fine. His brother drove him home.


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