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

This is VAERS ID 1259570



Case Details

VAERS ID: 1259570 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Male  
Location: Iowa  
Vaccinated:2021-04-06
Onset:2021-04-21
   Days after vaccination:15
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Dyspnoea, Fatigue, Musculoskeletal chest pain
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad)

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: Vitamins
Current Illness: None. Going to physician for sinus issues.
Preexisting Conditions: None.
Allergies: Penicillin
Diagnostic Lab Data: Did blood tests and CT on 4/23/2021.
CDC Split Type:

Write-up: On Wednesday the 21st he came home and was tired. It got gradually worse on the 22nd. Was also feeling rib pain on the right side. Was a little bit short of breath. Went to the ER on 4/23 and they gave him IV fluids and pain medications. Put him on Tylenol, Naproxen, and Eliquis. States today 4/26 he is feeling a little bit better.


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