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

This is VAERS ID 1210103



Case Details

VAERS ID: 1210103 (history)  
Form: Version 2.0  
Age: 45.0  
Sex: Male  
Location: Utah  
Vaccinated:2021-04-07
Onset:2021-04-14
   Days after vaccination:7
Submitted: 0000-00-00
Entered: 2021-04-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Cerebral venous sinus thrombosis, Dizziness, Headache, Hyperhidrosis, Magnetic resonance imaging abnormal, Nausea, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: losartan
Current Illness:
Preexisting Conditions: high blood pressure
Allergies:
Diagnostic Lab Data: MRI 4/14/21
CDC Split Type:

Write-up: nausea, vomiting, diaphoresis, dizziness, headaches, bilateral tranverse sinus thrombosis


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1210103

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