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

This is VAERS ID 1269669

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Case Details

VAERS ID: 1269669 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Wisconsin  
   Days after vaccination:13
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: CSF test abnormal, Condition aggravated, Electromyogram abnormal, Full blood count abnormal, Generalised oedema, Guillain-Barre syndrome, Hypertension, Lumbar puncture abnormal, Motor dysfunction, Musculoskeletal disorder, Respiratory distress
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Angioedema (broad), Haematopoietic leukopenia (broad), Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Akathisia (broad), Dyskinesia (broad), Dystonia (broad), Parkinson-like events (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Hypertension (narrow), Demyelination (narrow), Hypersensitivity (broad), Respiratory failure (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Amlodipine, Prevacid , vitamin D,
Current Illness: None known
Preexisting Conditions: Hypertension, obesity, lymphedema, obstructive sleep apnea
Allergies: Amoxicillin
Diagnostic Lab Data: Abnormal EMG, abnormal CSF tap, abnormal CBC,
CDC Split Type:

Write-up: Guillain Barre syndrome. Severe progressive motor impairment upper and lower extremities. Respiratory distress severe widespread edema, hypertension increase,

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