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

This is VAERS ID 1695257

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Case Details

VAERS ID: 1695257 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-09-13
Onset:2021-09-13
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821286 / N/A LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Fall, Head injury, Loss of consciousness, Nausea, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (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:
Current Illness:
Preexisting Conditions:
Allergies: penicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: On 9/13/2021 the patient had been sitting in a chair by the pharmacy after his Janssen COVID vaccine for almost 15 minutes and then got up to stand at the counter to ask the tech if he could leave yet. The tech told him he just had a little bit of time left to wait (maybe 3 more minutes?) when the patient fainted and fell to the floor. Another customer thought he hit his head on the way down. I was alerted by the tech & went to the patient who was lying on the floor unconscious but was breathing and had a strong carotid pulse. I told the tech to call an ambulance. After maybe a minute the patient started to make bending movements upwards with his legs and stretched one arm out and up. Then he started to lift his head a little and wake up. I told him to stay down on the floor and rest since he had fainted and may have hit his head. He said he was nauseous after another couple minutes. I gave him a wastebasket and he sat on the floor and threw up. After a few minutes the EMS crew came in and took over. They took him to the hospital.


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