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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1371593



Case Details

VAERS ID: 1371593 (history)  
Form: Version 2.0  
Age: 19.0  
Sex: Male  
Location: Tennessee  
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 202A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Hypotension, Immediate post-injection reaction, Paraesthesia, Tinnitus
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), Dehydration (broad), Hypokalaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE REPORTED
Current Illness: NONE REPORTED
Preexisting Conditions: NONE REPORTED
Allergies: PENICILLIN
Diagnostic Lab Data: On day of event (6/3/2021), patient blood pressure, pulse oximetry, heart rate, and respirations monitored by pharmacy staff until EMS arrived. Patient was hypotensive, oxygen saturation of $g95% on room air, Patient was provided water and evaluated by EMS. EMS confirmed no life-threatening event associated with vaccination. Patient was encouraged to follow-up with medical provider as soon as leaving the facility by both EMS and pharmacy staff.
CDC Split Type:

Write-up: Immediately following administration of the vaccine, the patient reported lightheadedness, tinnitus, and paresthesia of extremities. Patient experienced these symptoms within 15 seconds of vaccine administration. Symptoms persisted for approximately 15 minutes.


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