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

This is VAERS ID 1213016



Case Details

VAERS ID: 1213016 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New York  
Vaccinated:2021-03-19
Onset:2021-03-28
   Days after vaccination:9
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 0260364-14488 / 1 - / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Gait inability, Pain in extremity
SMQs:, Anticholinergic syndrome (broad), Dystonia (broad), Guillain-Barre syndrome (broad), Tendinopathies and ligament disorders (broad)

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: Losartan Janumet Norvasc Lipitor Hydrodiuril Xalatan opthal. sol. Timolol opthal. sol.
Current Illness: Neck pain
Preexisting Conditions: Diabetes HTN Hyperlipidemia Glaucoma
Allergies: No known allergies
Diagnostic Lab Data: None
CDC Split Type:

Write-up: 10 days after receiving Janssen COVID-19 vaccine I suddenly developed severe pain to my right leg. Pain was so severe I could not walk, I dragged myself into the medicine pantry and believing it could possibly be a thrombosis, I instantly took 2 baby aspirins. Although I wanted to call for help, I was too far from my phone therefore I began to massage the area and remained in place until the pain subsided enough to regain movement.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1213016

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