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

This is VAERS ID 1243858

Case Details

VAERS ID: 1243858 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Male  
Location: Florida  
   Days after vaccination:21
Submitted: 0000-00-00
Entered: 2021-04-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Unknown       Purchased by: ?
Symptoms: Activated partial thromboplastin time shortened, Alanine aminotransferase increased, Anion gap normal, Aspartate aminotransferase increased, Base excess increased, Blood albumin decreased, Blood alkaline phosphatase normal, Blood bicarbonate normal, Blood bilirubin normal, Blood calcium normal, Blood chloride normal, Blood creatinine increased, Blood glucose normal, Blood lactic acid, Blood pH normal, Blood potassium normal, Blood sodium normal, Blood urea increased, COVID-19, Carbon dioxide normal, Continuous positive airway pressure, Dyspnoea, Fraction of inspired oxygen, Glomerular filtration rate normal, Haematocrit normal, Haemoglobin normal, International normalised ratio increased, Mean cell haemoglobin increased, Mean cell volume normal, Occupational exposure to SARS-CoV-2, Oxygen saturation decreased, PCO2 normal, PO2 decreased, Platelet count normal, Protein total increased, Prothrombin time prolonged, Red blood cell count normal, Red cell distribution width increased, SARS-CoV-2 test positive, White blood cell count increased
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (broad), Liver related investigations, signs and symptoms (narrow), Liver-related coagulation and bleeding disturbances (narrow), Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Tumour lysis syndrome (broad), Respiratory failure (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Atorvastatin-dose unknown Metoprolol-dose unknown Pantoprazole-dose unknown
Current Illness: Unknown
Preexisting Conditions: Hypertension GERD High Cholesterol Obesity Diabetes-NIDDM
Allergies: No known drug allergies
Diagnostic Lab Data: sodium 141; potassium 3.8; chloride 103; carbon dioxide 29.1; glucose 164; bun 22; serum creatinine 1.5; calcium 9.1; anion gap 8.9; eGFR non-african american 49; eGFR african american 60; total protein 8.4; albumin 2.6; bilirubin-total 0.5; alkaline phos 63; SGOT(AST) 43; SGPT (ALT) 82; WBC 17.1; RBC COUNT 5.25; Hemoglobin 15.8; Hematocrit 47.6; MCV 91; MCH 33.2; RDW 14.7; Platelet count 348,000; lactic acid 3.0; PT 14.4; INR 1.3; PTT 34; FiO2 100%; pH 7.455; pCO2 40.20; pO2 58.30; Base excess 4; HCO3 28.20; O2 sat 90%
CDC Split Type:

Write-up: Patient states that he received Janssen Covid-19 vaccine on 3/31/2021 and was exposed to a covid-19 positive co-worker on 4/2/2021 and tested positive for Covid-19 on 4-10-2021. The patient came to the hospital emergency room via EMS on 4/21/2021 at 0912 complaining of shortness of breath. According to EMS the patient had an O2 saturation of 57% on room air and was place on CPAP, 15 liters, and transported to the ER.

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