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

This is VAERS ID 1172503

Case Details

VAERS ID: 1172503 (history)  
Form: Version 2.0  
Age: 69.0  
Sex: Male  
Location: New York  
   Days after vaccination:14
Submitted: 0000-00-00
Entered: 2021-04-06
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802072 / 1 RA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, CSF protein increased, Guillain-Barre syndrome, Lumbar puncture abnormal, White blood cell count decreased
SMQs:, Haematopoietic leukopenia (narrow), Peripheral neuropathy (narrow), Systemic lupus erythematosus (broad), Guillain-Barre syndrome (narrow), Demyelination (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

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, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Valsartan-HCTZ, rosuvastain, ASA
Current Illness: None
Preexisting Conditions: HTN, HLD
Allergies: No known allergies
Diagnostic Lab Data: Lumbar puncture with CSF protein 219, WBC 3
CDC Split Type:

Write-up: Patient with progressive ascending weakness over 2 weeks. Diagnosed with Guillain-Barre Syndrome.

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