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

This is VAERS ID 1258926



Case Details

VAERS ID: 1258926 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-16
Onset:2021-04-21
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802070 / N/A - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Dyspnoea, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: covid test positive SARS-CoV-2 (COVID-19), Micro Detected 4/24/2021
CDC Split Type:

Write-up: covid symptoms SOB $g 14 days after vaccine ( 4/21/21) covid test positive


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