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

This is VAERS ID 1079139



Case Details

VAERS ID: 1079139 (history)  
Form: Version 2.0  
Age: 43.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-03-06
Onset:2021-03-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Blood lactic acid increased, Chills, Dehydration, Heart rate increased, Pyrexia, Tremor
SMQs:, Lactic acidosis (narrow), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow)

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: Flu shot in 2014 where it ended up acting as if he had the full round of the flu
Other Medications: Palenziq, Forteo, Protonix, Vitamin D, B complex
Current Illness: None
Preexisting Conditions: PKU, severe osteoporosis, GERD, mild hernia
Allergies: None
Diagnostic Lab Data: Was told that his bloodwork came out completely normal minus a minor lactate elevation due to dehydration
CDC Split Type:

Write-up: Fever of 104, heart rate in 160''s, rigor, severe back pain. 911 called and ambulance brought to Hospital at 1am. Took 3 bags of fluids, Ativan, Tylenol and Toradol to get the heart to the 110''s over the 3 hours there. It is now 12:30 on the following day (3/7) and the fever, shakes, and elevated heart is starting up again but not to the extreme of last night


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