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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1371293



Case Details

VAERS ID: 1371293 (history)  
Form: Version 2.0  
Age: 18.0  
Sex: Female  
Location: Missouri  
Vaccinated:2021-06-03
Onset:2021-06-03
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-03
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Dizziness, Pallor
SMQs:, Anticholinergic syndrome (broad), Vestibular disorders (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: meningitis, HPV
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received J&J vaccine and walked to sit down for her post injection wait time. Patient had previously fainted after a vaccine so she was suppose to sit for 30 minutes anyway. Patient immediately after sitting down got extremely light headed, pale, and dizzy. We immediately moved her to the floor and put her feet up. After approximately 3 minutes, patient regained color and was feeling a lot better. EMS was called but father who was with her called to cancel and refuse after patient felt better so quickly. Patient had history of anxiety with shots and it seemed to be truly an anxiety issue.


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