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

This is VAERS ID 1371651



Case Details

VAERS ID: 1371651 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Male  
Location: North Carolina  
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 2055A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood glucose normal, Condition aggravated, Electrocardiogram normal, 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: Yes, patient reported fainting during childhood vaccine
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: No Known Allergies
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient had two syncope events after vaccine administration lasting approximately 5-10 seconds. He was monitored continuously. EMS were called and checked blood pressure, blood glucose, and did an EKG -all values were normal. Additionally, patient remained being monitored for 30 minutes until picked up by family member. Patient recovered from adverse events.


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