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

This is VAERS ID 1328558



Case Details

VAERS ID: 1328558 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Alabama  
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 205A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Loss of consciousness, Syncope
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), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: No Known Allergies
Diagnostic Lab Data: Blood pressure 05/18/2021 @ 10:12 am was 113/60
CDC Split Type:

Write-up: Patient fainted within 5 minutes of vaccine administration. She came to within 15 seconds, at that time she was laid down in a supine position. Once she stabilized and identified who she was, where she was, and what had just happened, I sat her up and checked her blood pressure (113/60 at 10:12am). I stayed with the patient and continued to assess the situation and her until EMS arrived and took over care.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1328558


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