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

This is VAERS ID 1315169



Case Details

VAERS ID: 1315169 (history)  
Form: Version 2.0  
Age: 65.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-04-28
Onset:2021-05-02
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204AZIA / UNK LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Unevaluable event
SMQs:

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: Blood thinkers. Very minor ones.
Current Illness: no
Preexisting Conditions: slight cold and minor heart attack 2009
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: Facility


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1315169


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