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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1172339

Case Details

VAERS ID: 1172339 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Virginia  
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802072 / 1 UN / IM

Administered by: Private       Purchased by: ?
Symptoms: Guillain-Barre syndrome, Hypoaesthesia, Lumbar puncture, Muscular weakness
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Noninfectious encephalopathy/delirium (broad), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: amLODIPine aspirin 81 mg Tablet, diazePAM gabapentin hydroCHLOROthiazide losartan nitroglycerin omeprazole oxyCODONE-acetaminophen potassium chloride SA (K-DUR) tiZANidine
Current Illness:
Preexisting Conditions: Type 2 DM, GERD, Chronic low back pain
Allergies: NKA
Diagnostic Lab Data: Lumbar puncture on 04/03/21
CDC Split Type:

Write-up: A week after the patient had the vaccine he developed weakness with numbness in the lower extremities. Patient continued to get worse and was admitted on 04/03 with concerns for Guillain-Barr? syndrome ( GBS). Patient is currently getting treatment for GBS.

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