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

This is VAERS ID 1212936



Case Details

VAERS ID: 1212936 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Minnesota  
Vaccinated:2021-04-06
Onset:2021-04-07
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray abnormal, Chest pain, Computerised tomogram thorax abnormal, Dizziness, Dyspnoea, Electrocardiogram normal, Fibrin D dimer increased, Injection site pain, Lung opacity, Pain, Painful respiration, Paraesthesia, Pulmonary embolism, Ultrasound Doppler normal
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Haemorrhage laboratory terms (broad), Interstitial lung disease (narrow), Anticholinergic syndrome (broad), Embolic and thrombotic events, venous (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Vestibular disorders (broad), Infective pneumonia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Allopurinol, Finasteride
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG - normal Chest X-ray - showed ground glass appearance D-Dimer - elevated results which indicated potential thrombus CT Scan - showed many pulmonary emboli, in both lungs, top/bottom Leg Ultrasound - no trace / evidence of DVT or clotting
CDC Split Type:

Write-up: Got COVID (Janssen) vaccine shot on April 6th at noon. Felt fine Tuesday and went to bed as normal. Woke up April 7th at 7AM with sharp pains in my left shoulder (same side as shot) and slight shortness of breath, and slight chest pain in the left quadrant of my torso (same side as shot). Proceeded to take Advil and seemed to help a bit. Minor aches/pains and shortness of breath throughout the day until about 8PM. At this time shoulder chest pain became more severe, and breathing became very strained, short, and painful. Pain and breathing kept getting worse and at midnight on Wednesday night thought I was having a heart attack due to extreme chest pain, couldn''t breath, lightheaded, dizzy, tingly extremities. My wife drove me to ER at 12:30 AM Thursday.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1212936

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