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

This is VAERS ID 1332011



Case Details

VAERS ID: 1332011 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: Rhode Island  
Vaccinated:2021-04-06
Onset:2021-05-04
   Days after vaccination:28
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / UNK - / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Cardiac function test, Computerised tomogram, Dizziness, Dysstasia, Intensive care, Nausea, Orthostatic hypotension, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Xaretel Flecainide aspirin Metropol amlodipine / benazepril crestor
Current Illness: Afib ... Had Web Sl implant for brain aneurysm last July ... might of had some type of infection
Preexisting Conditions: Same
Allergies: None
Diagnostic Lab Data: CT Scan lower body ...blood test ...a lot of heart test
CDC Split Type:

Write-up: Wasn?t able to stand up at all... nausea fainting dizziness etc... had to take rescue twice within 5 days... was in the ICCU unit at one point.. diagnosed with orthostatic hypotension


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