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From the 4/23/2021 release of VAERS data (an older release, current is 7/16/2021):

This is VAERS ID 1185892



Case Details

VAERS ID: 1185892 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: Pennsylvania  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dizziness, Impaired driving ability, Loss of consciousness, Nausea
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), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: syncope, details unknown
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: patient experienced a wave of nausea, light-headedness, and briefly lost consciousness during vaccination. When she lost consciousness, I supported her weight and she remained in the chair for approx 15 seconds until she regained consciousness. I had two technicians to assist in calling a code white and documenting the event. At 10:43 am, patient lost consciousness and regained 15 seconds later. Once I knew the patient was stable enough to support her own weight, i held her hands to make sure she was not going to lose consciuosness again. I administered an ice pack and a cool towel at 10:45 am. Code white was responded to by associates from AP and manager. I observed the patient for 15 minutes, and AP associate observed for another 15 minutes for a total of 30 minutes. The patient recovered fully and had a friend drive her home.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210423&IDNUMBER=1185892


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