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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1381756

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Case Details

VAERS ID: 1381756 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-06-08
Onset:2021-06-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Cold sweat, Eye colour change, Fall, Hyporesponsive to stimuli
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Glaucoma (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Thyroid Medicatoin
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: None
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: Client was vaccinated at 14:02 with Janssen vaccine and was then going to be observed for 15 minutes. Client requested to be observed in the lobby waiting area instead of in the exam room. Client walked himself to the chair, sat down and began to type on his phone. About 8 minutes into his observation, client began to fall forward and did not appear as responsive. Staff immediately tended to client and spoke to client requesting a response. Minimal response was given. 911 was called and responded within 2 minutes. Client was clammy, cool to the touch and eyes appeared glossy and dark. Client''s blood pressure was 70/50 at 14:12. Med then arrived and BP was 53/35. At 14:20 (first BP taken when med arrived). Client became responsive but blood pressure minimally improved. Client was taken to the hospital and in agreement.


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