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

This is VAERS ID 1082037



Case Details

VAERS ID: 1082037 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-06
Onset:2021-03-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-03-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802068 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Malaise
SMQs:

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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: PANTOPRAZOLE 40MG, AMLODIPINE 5MG, HYDRALAZINE 50MG, SODIUM BICARB 650MG
Current Illness:
Preexisting Conditions: MYELOMA, TYPE 2 DIABETES, KIDNEY DISEASE
Allergies: NO KNOWN ALLERGIES
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT''S WIFE STATED THAT HE HAD SYMPTOMS SIMILAR TO COVID AND WAS ADMITTED INTO THE HOSPITAL.


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