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From the 11/12/2021 release of VAERS data:

This is VAERS ID 1694936

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Case Details

VAERS ID: 1694936 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Female  
Location: Georgia  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Consciousness fluctuating, Disorientation, Dizziness, Hot flush, Hypotonia, Syncope, Unresponsive to stimuli, Vomiting
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Hypoglycaemia (broad), Dehydration (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:
Current Illness:
Preexisting Conditions: Asthma
Allergies: Peanuts
Diagnostic Lab Data:
CDC Split Type:

Write-up: Minutes after receiving the shot, the patient began to feel light headed. Shortly after, she slumped over in the chair where we ask patients to sit after the shots are administered. The staff pharmacist attended to the patient immediately and stayed with her throughout the incident. She was unresponsive at first, but eventually would rotate between moments of consciousness and syncope. She had to vomit once, had hot flashes, and was disoriented. We focused on trying to keep her attention and preventing her from losing consciousness again. We provided an ice pack to help with her hot flashes. An ambulance was notified shortly into the event when it was apparent that she was not improving. When the paramedics arrived, we provided as much information as we could. We were able to get in touch with a family member, and the paramedics left with her on a stretcher.

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