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From the 5/7/2021 release of VAERS data (an older release, current is 10/15/2021):

This is VAERS ID 1091766



Case Details

VAERS ID: 1091766 (history)  
Form: Version 2.0  
Age: 25.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-03-11
Onset:2021-03-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 RA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dizziness, Hypoacusis, Hypoaesthesia, Immediate post-injection reaction, Nervousness, Vision blurred
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Hearing impairment (narrow), Vestibular disorders (broad), Hypersensitivity (narrow), 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: levothyroxine
Current Illness:
Preexisting Conditions:
Allergies: Amoxicillin
Diagnostic Lab Data: Client seen by EMT; Monitoring BP; Client drinking water; Client calling husband to take her to FSED; EMT monitoring client at this time.
CDC Split Type:

Write-up: Per client: As vaccine went in arm went numb, then felt light headed as walking to chair, while sitting vision went blurry and hearing went muffled; feels a little shaky; EMT checked BP 95/66; At 1427 vision and hearing better; BP range 101/68; Client reports her usually BP is "average"; at 1433 BP per EMT 102/72 while sitting; at 1436 BP per EMT while 93/68 standing; client continues to feel lightheaded; EMT discussed treatment options with client to transport her to the free standing emergency department (FSED) or call husband to pick her up. Client decided to call husband to come and pick her up; EMT recommends her to go to FSED.


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Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210507&IDNUMBER=1091766

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