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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1204923

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Case Details

VAERS ID: 1204923 (history)  
Form: Version 2.0  
Age: 66.0  
Sex: Female  
Location: Oregon  
Vaccinated:2021-03-12
Onset:2021-03-25
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1085018 / 1 UN / IM

Administered by: Other       Purchased by: ?
Symptoms: Guillain-Barre syndrome
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 19 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: apixaban (ELIQUIS) , cetirizine (ZYRTEC), digoxin, Ergocalciferol, Vitamin D2, furosemide, levothyroxine, potassium chloride (KLOR-CON M, VITAMIN B COMPLEX ORAL
Current Illness: heart failure, restrictive pericarditis
Preexisting Conditions: Hodgkins, BCL, afib, heart failure
Allergies: flecainide, amiodarone
Diagnostic Lab Data: Diagnosis of exclusion
CDC Split Type:

Write-up: Guillain-Barr? syndrome


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