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

This is VAERS ID 1263510



Case Details

VAERS ID: 1263510 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: New Jersey  
Vaccinated:2021-04-08
Onset:2021-04-11
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Feeling cold, Headache, Myalgia, Pyrexia
SMQs:, Rhabdomyolysis/myopathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (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? No
Previous Vaccinations:
Other Medications: 1. daily baby aspirin 81 mg 2. vitamin c : 1000 mg twice a day 3. vitamin d : 4000 mg iu daily 4. zinc : 50 daily 5. melatonin for insomnia (1-10mg)
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, Mucles pain, cold, headache


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1263510


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