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

This is VAERS ID 1351028

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Case Details

VAERS ID: 1351028 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Tennessee  
Vaccinated:2021-03-17
Onset:2021-03-18
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 RA / IM

Administered by: Military       Purchased by: ?
Symptoms: Cardiac monitoring abnormal, Heart rate abnormal, Heart rate increased, Palpitations, Rash, Urticaria
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient adverse events and reactions the following: Breakout in rashes, hives and wheals all of his body. He had to be injected with two epipens and other meds to avoid anaphylaxis shock. Patient has an abnormal heart rate and gets monitored weekly on the effects of the shot. Breakout in rashes, hives, wheals, and have fast/pounding heartbeat daily.


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