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

This is VAERS ID 1393231



Case Details

VAERS ID: 1393231 (history)  
Form: Version 2.0  
Age: 54.0  
Sex: Male  
Location: Illinois  
Vaccinated:2021-04-28
Onset:2021-06-03
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-06-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 204A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Atrial flutter, Blood test, Cardiac ablation, Chills, Electrocardiogram, Heart rate increased, Pain, Pyrexia
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Supraventricular tachyarrhythmias (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Baclofen, Testosterone, rosuvastatin, multivitamin, turmeric
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: Cardiac ablation performed May 24, 2021 to address atrial flutter EKGs blood work rapid heart rate (166 beats per minute) vs. normal rate of 55 beats per minute
CDC Split Type:

Write-up: Severe immune system response. High fever, chills, aches. Set off atrial flutter and was admitted to emergency room/hospital for cardiac ablation


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