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

This is VAERS ID 1376019



Case Details

VAERS ID: 1376019 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Virginia  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821288 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pallor, 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: faints with vaccinations or needles
Other Medications: None
Current Illness: None
Preexisting Conditions: none
Allergies: NO known allergies
Diagnostic Lab Data: bp 102/50 hr 57 at 16:00 bp 112/67 hr 62 at 16:14
CDC Split Type:

Write-up: Patient had received the Janssen Covid 19 vaccine about 8 minutes before. He was in waiting area when I noticed that he was becoming pale. I spoke with patient and he said that he sometimes faints with vaccinations but didn''t mention it during counseling because it had been several years since he had fainted. Place cold compress on back on head and place patient flat in the floor with feet elevated. He fainted as we were assisting him to the floor. After elevating feet patient became cogitative and wanted to sit up in the chair. Assisted patient to chair, took blood pressure A 1600 102/50 hr 57. Asked patient to wait another 15 minutes before leaving. continued to monitor patient and rechecked vitals at 16:14 bp 112/67 heart rate 62. Patient stated that "they were fine." and wanted to leave. will leave note with phone number to check on patient in the am.


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