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From the 6/4/2021 release of VAERS data:

This is VAERS ID 1226944



Case Details

VAERS ID: 1226944 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Male  
Location: Massachusetts  
Vaccinated:2021-04-11
Onset:2021-04-11
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Cough, Fatigue, Headache, Pain, Palpitations, Rash, Rash erythematous, Rash papular, Rash pruritic, Skin warm
SMQs:, Anaphylactic reaction (narrow), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: None
Allergies: N/A
Diagnostic Lab Data: Consulted PCP. No tests or labs were ordered.
CDC Split Type:

Write-up: 4/11 Sunday afternoon fatigue and tired. 4/11 Sunday night into 4/12 Monday morning woke up with severe coughing, heart racing, and a rash. The rash was present on the right side of body, chest, arm, ribs. The rash was round bumps, raised, bright red, severe itching, and warm to touch. The rash and itching presented for 5 days. Tuesday severe headache and body aches present in addition to other symptoms. Heart racing continues still to this day 4/18.


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