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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1367696



Case Details

VAERS ID: 1367696 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-06-02
Onset:2021-06-02
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

Administered by: School       Purchased by: ?
Symptoms: Injection site haemorrhage, Injection site swelling
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: unknown/not reported
Allergies: denies
Diagnostic Lab Data: na
CDC Split Type:

Write-up: near immediate lump at injection site. minimal bleeding when withdrawing needed. lump measured at injection site 18 mm x 13 mm. no active bleeding, no erythema or bruising. Spoke to patient for 8 minutes during which time no additional signs or symptoms were noted. Discussed next steps. Will call to check on status in 4-5 hours and again in 20-24 hours. Advised to contact our clinic or PCP with any additional questions or concerns. Has appt with PCP 6/3/21 for annual PE. Advised to monitor site periodically.


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