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

This is VAERS ID 1233116



Case Details

VAERS ID: 1233116 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Connecticut  
Vaccinated:2021-04-06
Onset:2021-04-11
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chest X-ray normal, Chest discomfort, Dizziness, Dyspnoea, Electrocardiogram normal, Headache, Laboratory test normal, Myocardial necrosis marker normal, Nausea, Pain in extremity
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vitamin D, Vitamin B-Complex, Melatonin, Fish Oil
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: EKG and chest X-ray performed, both clear. Cardiac enzyme and other basic blood test all within normal range. Blood pressure slightly elevated (continuing).
CDC Split Type:

Write-up: Leg pain, pressure headaches and chest tightness resulting in ER visit 4/12. Attending physician noted no visible signs of clots. Occasional shortness of breath and brief bursts of dizziness and nausea (not necessarily together) persist, as do minor headaches.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1233116


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