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

This is VAERS ID 1375610

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Case Details

VAERS ID: 1375610 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Male  
Location: New York  
Vaccinated:2021-05-26
Onset:2021-05-28
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Blood test, Bronchitis, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (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? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Lisinopril 20 mg
Current Illness:
Preexisting Conditions:
Allergies: Pennicillin
Diagnostic Lab Data: 5/29 blood test for blood clots 5/29 tov6/2 abutirol mist therapy
CDC Split Type:

Write-up: Fever, bronchitus


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