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

This is VAERS ID 1213004



Case Details

VAERS ID: 1213004 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-04-12
Onset:2021-04-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Peripheral swelling, Ultrasound Doppler normal
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: ALBUTEROL 90MCG (CFC-F) 200D ORAL INHL INHALE 2 PUFFS BY MOUTH EVERY 6 HOURS AS NEEDED FOR BREATHING ASPIRIN 81MG CHEW TAB CHEW one tab daily DICLOFENAC NA 1% TOP GEL APPLY 1 MODERATE AMOUNT TO THE SKIN FOUR TIMES
Current Illness: None
Preexisting Conditions: Carpal tunnel syndrome Edema of lower extremity History of repair of rupture of quadriceps tendon Diabetes mellitus Benign essential hypertension Lumbar radiculopathy Overactive bladder Gastroesophageal reflux disease Hyperlipidemia Vitamin D deficiency Neck Pain Pain In Leg Benign prostatic hypertrophy without outflow obstruction Shoulder Joint replacement Status
Allergies: METFOMRIN CAUSES INDIGESTION
Diagnostic Lab Data: Doppler of left lower extremity was negative for Deep Vein Thrombosis
CDC Split Type:

Write-up: Patient called reporting right lower extremity swelling that started in his right ankle about 45 minutes after his vaccination. The swelling gradually went up to his calf.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1213004

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