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

This is VAERS ID 1263096



Case Details

VAERS ID: 1263096 (history)  
Form: Version 2.0  
Age: 82.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-10
Onset:2021-04-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Private       Purchased by: ?
Symptoms: Confusional state, Decreased appetite
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: prior gastric cancer and colon cancer, HTN, DM, dementia
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: decreased appetite and confusion for 2 weeks since getting vaccine


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1263096


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