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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1264039

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Case Details

VAERS ID: 1264039 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Alabama  
Vaccinated:2021-03-17
Onset:2021-04-18
   Days after vaccination:32
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: Ataxia, Guillain-Barre syndrome, Immunoglobulin therapy, Lumbar puncture abnormal, Magnetic resonance imaging head normal, Magnetic resonance imaging spinal normal
SMQs:, Peripheral neuropathy (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Omepraozole, Naproxen, Tadalafil, Atorvastatin, Aspirin
Current Illness: None
Preexisting Conditions: Hypertension, coronary artery disease, hypothyroidism
Allergies: None
Diagnostic Lab Data: MRI Lumbar Spine, MRI Brain, Lumbar Puncture
CDC Split Type:

Write-up: Patient developed ataxic gait determined to be Guillan-Barre syndrome. Was treated with course of IVIg with improvement but not resolution.


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