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

This is VAERS ID 1377911

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Case Details

VAERS ID: 1377911 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Maine  
Vaccinated:2021-04-25
Onset:2021-05-25
   Days after vaccination:30
Submitted: 0000-00-00
Entered: 2021-06-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / IM

Administered by: School       Purchased by: ?
Symptoms: Peripheral swelling, Temperature difference of extremities, Ultrasound scan
SMQs:, Cardiac failure (broad), Angioedema (broad), 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? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Vimpat, rosuvastatin
Current Illness: N/A
Preexisting Conditions: Partial epilepsy with impairment of consciousness, intractable, History of traumatic brain injury, Hyperlipidemia, History of venous thromboembolism, Presence of IVC filter, Androgen deficiency
Allergies: N/A
Diagnostic Lab Data: U/S of left lower leg on 5/25
CDC Split Type:

Write-up: Patient noticed swelling in lower left leg on 5/18 and called office on 5/25 with swelling and temperature change in left leg, he was sent to the emergency room.


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