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

This is VAERS ID 1237132



Case Details

VAERS ID: 1237132 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-04-08
Onset:2021-04-19
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Abdominal pain, Pain in extremity
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), 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: unnknown
Current Illness: unknown
Preexisting Conditions: unknown
Allergies: none
Diagnostic Lab Data: unknown Follow up phone call on 04/20/21 patient reported going to urgent care facility and reports receiving no treatment despite lingering symptoms.
CDC Split Type:

Write-up: Pt phoned our office on 04/19/21 with complaints of abdominal pain and bilateral leg pain. Pt was instructed to seek immediate health care for evaluation. He refused. Pt was very agitated and concerned about covering costs of medical care despite having health care insurance. Pt again instructed to seek health care and he refused.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1237132


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