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From the 9/3/2021 release of VAERS data:

This is VAERS ID 1454657



Case Details

VAERS ID: 1454657 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-07-07
Onset:2021-07-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1816022 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Hyperhidrosis, Syncope, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Accidents and injuries (narrow), 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: every vaccine and blood draw
Other Medications: Midodrine
Current Illness: N/A
Preexisting Conditions: Vagovasal Syncope
Allergies: N/A
Diagnostic Lab Data:
CDC Split Type:

Write-up: Janssen COVID-19 vaccine EUA. Technician administered Janssen Covid-19 vaccine and upon removal of needle patient began to tense up and slide down chair. He began to shake and sweat. Technician asked patient if he was okay and his wife responded "no, he is passing out." The technician then went to get the pharmacist. The patient passed out for 5-10 seconds and then began coming back to. Patient was provided with ice packs and cold water. Pharmacist had the patient lie down with feet elevated until patient felt well enough to stand back up. He was comfortable to leave and divulged that he takes midodrine daily for his vagovasal syncope and has a history of passing out every time he is injected with a vaccine or has a blood draw.


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