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From the 6/11/2021 release of VAERS data:

This is VAERS ID 1242758



Case Details

VAERS ID: 1242758 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-04-05
Onset:2021-04-21
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Chest pain, Cough, Diarrhoea, Dyspnoea, Myalgia, Pyrexia, SARS-CoV-2 test positive, Vomiting
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None known
Preexisting Conditions: None known
Allergies: No known allergies
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt received first and only dose of Janssen J&J COVID vaccine on 4/5/2021. 2 weeks later, patient would have been considered to reach full immunity. On 4/21/2021, pt went to the ED with symptoms of COVID and tested positive via SARS-CoV-2 PCR. Pt was not ill enough to be admitted. "Symptoms include nonproductive cough, pleuritic chest pain, shortness of breath, arthralgias, myalgias, fever, vomiting, diarrhea."


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