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

This is VAERS ID 1213406



Case Details

VAERS ID: 1213406 (history)  
Form: Version 2.0  
Age: 79.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-05
Onset:2021-04-07
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Computerised tomogram, Facial pain, Hypoaesthesia, Pain of skin, X-ray
SMQs:, Peripheral neuropathy (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: CARVEDILOL, RAMIPRIL
Current Illness: N/A
Preexisting Conditions: HEART CONDITION..HE WAS ON COREG AND RAMIPRIL ACCORDING TO HIS LETTER
Allergies: NO KNOWN
Diagnostic Lab Data: heart X ray CAT scan
CDC Split Type:

Write-up: 4/5/21 vaccinated 4/7/21 numbed face.,right side from nose to ear and from upper lip to top of scalp. painful face and scalp like a severe burn.


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