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

This is VAERS ID 1395591



Case Details

VAERS ID: 1395591 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Male  
Location: Virginia  
Vaccinated:2021-03-11
Onset:2021-06-03
   Days after vaccination:84
Submitted: 0000-00-00
Entered: 2021-06-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN N/A / N/A AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Acute kidney injury, Dehydration, Dyspnoea, Glomerular filtration rate normal, Hyperhidrosis, Laboratory test, Supraventricular tachycardia
SMQs:, Rhabdomyolysis/myopathy (broad), Acute renal failure (narrow), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Supraventricular tachyarrhythmias (narrow), Shock-associated circulatory or cardiac conditions (excl torsade de pointes) (broad), Torsade de pointes, shock-associated conditions (broad), Hypovolaemic shock conditions (broad), Toxic-septic shock conditions (broad), Anaphylactic/anaphylactoid shock conditions (broad), Hypoglycaemic and neurogenic shock conditions (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Tumour lysis syndrome (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Prescriptions: Atorvastatin [Lipitor], Celecoxib [Celebrex], Cyclobenzaprine [Flexeril], Duloxetine HCl [Cymbalta], & Gabapentin [Neurontin]; Over-the Counter: Cetirizine HCl [Zyrtec], Diphenhydramine HCl [Benadryl], Fish Oil, Fluticasone
Current Illness: None
Preexisting Conditions: High cholesterol, high blood pressure, bone spurs & arthritis in cervical spine, multilevel degenerative disk disease in lumbar spine.
Allergies: Occasional mild itching when taking opioids.
Diagnostic Lab Data: All tests on 6/3/2021. Hemolysis Index 34, EGFR 50.8.
CDC Split Type:

Write-up: Heart rate 186, shortness of breath, profuse sweating. Successfully treated with IV adenosine [ADENOCARD]. Diagnosed as SVT (supra ventricular tachycardia), AKI (acute kidney injury), and dehydration.


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