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

This is VAERS ID 1079633



Case Details

VAERS ID: 1079633 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-03-05
Onset:2021-03-05
   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 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Laboratory test, Muscular weakness, Pain, Restless legs syndrome, Tremor, Urine analysis
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Atorvastatin, Famotidine, Montelukast Aspirin, Caltrate D, D3, Multivitamin, Systane eye drops, Vitamin C
Current Illness: None
Preexisting Conditions: None
Allergies: Codeine, Sulfa
Diagnostic Lab Data: Blood test and urinalysis at Hospital on 3/5/21
CDC Split Type:

Write-up: 7:30pm unusual restlessness in both legs; by 8:30pm dull constant pain increased, legs were weak, knees wobbly, hands shaking. Pain in legs became intense; I could not sit on the toilet. Went to emergency room of Hospital at 9pm; no medications given. Pain calmed by 10pm, but sensation in legs returned at 11pm and continued until discharge at 1:15am on 3/6. Took Tylenol PM at home for moderate pain in legs and went to bed. Awakened next morning to no pain, had breakfast and went back to bed until noon. Feeling fine since that time.


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