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

This is VAERS ID 1373266

Case Details

VAERS ID: 1373266 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Minnesota  
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN LC1820095 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Chills, Headache, Pain in extremity, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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: Alcoholic (Every Fridays- one to two beers.); Non-smoker
Preexisting Conditions: Comments: The patient did not have any history of drug abuse or illicit drug use.
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210604811

Write-up: ACHY LEGS; CHILLS; FEVER; HEADACHE; This spontaneous report received from a patient concerned a 35 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included alcoholic, and non smoker, and other pre-existing medical conditions included the patient did not have any history of drug abuse or illicit drug use. The patient experienced drug allergy when treated with guaifenesin for hyperactivity. The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: LC1820095 expiry: 04-JUL-2021) dose was not reported, administered on 01-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 01-JUN-2021, the subject experienced headache. On 02-JUN-2021, the subject experienced achy legs. On 02-JUN-2021, the subject experienced chills. On 02-JUN-2021, the subject experienced fever. The action taken with covid-19 vaccine was not applicable. The patient recovered from chills on 02-JUN-2021, and had not recovered from headache, fever, and achy legs. This report was non-serious.

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