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

This is VAERS ID 1228392



Case Details

VAERS ID: 1228392 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: Indiana  
Vaccinated:2021-04-10
Onset:2021-04-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / N/A LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Chills, Fatigue, Headache, Injection site pain, Pain
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril HCTZ 25 mg tablet one per day Levothyroxine 125 MCG tablet one per day Astorvastatin 40 MG one tablet per day Multivitamin
Current Illness: N/A
Preexisting Conditions: Hypertension Elevated cholesterol
Allergies: Melon fruits Banana
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 24 hours after injection Pain at injection site Chills Body Aches Headache Fatigue


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