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

This is VAERS ID 1470210



Case Details

VAERS ID: 1470210 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: South Carolina  
Vaccinated:2021-07-13
Onset:2021-07-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Feeling hot, Hyperhidrosis, Loss of consciousness, Malaise, Musculoskeletal stiffness, Tremor
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dystonia (broad), Parkinson-like events (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Arthritis (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:
Other Medications: unknown
Current Illness: none at time of vaccination and unknown up to one month prior
Preexisting Conditions: none
Allergies: no known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient received vaccine dose at 4:43pm. At approximately 4:48pm, she stood up to tell staff that she was feeling ok and wanted to pick up an item in the store. A staff member saw that she looked unwell and asked if she was ok and she said no. She passed out at that moment. She was unconscious for approximately 5-10 seconds. Her body became stiff and her shoulder/arm trembled during that time frame of being unconscious. She refused an ambulance. She remained in the pharmacy for 30 minutes until she no longer felt light-headed. During the 30 minutes, she felt light-headed, hot and was sweating. She said she felt fine after the 30 minute wait.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1470210


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