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

This is VAERS ID 1337279



Case Details

VAERS ID: 1337279 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Unknown  
Vaccinated:2021-05-04
Onset:2021-05-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / -

Administered by: Unknown       Purchased by: ?
Symptoms: Malaise
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient stated " I don''t feel ok'' EMS came by patient side. Lead staff been aware of it. Patient vitals took by EMS BP 118/86, HR 61, O2 96. After 10 minutes lay flat and vitals taken. Patient Stated I feel good. Patient refused to go to the hospital.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1337279


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