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From the 7/23/2021 release of VAERS data:

This is VAERS ID 1312039



Case Details

VAERS ID: 1312039 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: Vermont  
Vaccinated:2021-04-30
Onset:2021-05-02
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-05-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chills, Culture negative, Fatigue, Memory impairment, Pyrexia, Urinary tract infection, Urine analysis abnormal
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Depression (excl suicide and self injury) (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Vivelle, progesterone
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: urinalysis and culture, 05/05/2021
CDC Split Type:

Write-up: severe chills, fever, fatigue, urinary tract infection (no symptoms before 5/02, more memory problems than previous ( normal aging, not dementia).


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1312039


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