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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1351344

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Case Details

VAERS ID: 1351344 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-04-10
Onset:2021-04-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Dyspnoea, Headache, Pain in extremity, X-ray
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad)

Life Threatening? No
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: omeprazole 20 mg delayed release
Current Illness: none
Preexisting Conditions: none
Allergies: Penicillin
Diagnostic Lab Data: blood work, ct scan, xrays
CDC Split Type:

Write-up: Experienced severe headache, leg pain, shortness of breath. Was admitted to Hospital on 4/11/2021. Discharged 4/12/2021. Follow up w Primary doctor


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