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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1417887



Case Details

VAERS ID: 1417887 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-04
Onset:2021-06-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / UNK - / SYR

Administered by: Other       Purchased by: ?
Symptoms: Chills, Excessive eye blinking, Headache, Sleep disorder, Vision blurred
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Ocular motility disorders (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness:
Preexisting Conditions: Celiac disease
Allergies: Gluten
Diagnostic Lab Data:
CDC Split Type:

Write-up: Received in right arm/shoulder at 15:39. Later when lying in bed my teeth started clattering and I got the chills which lasted around 20 mins. When this passed I got a bad headache, location was forehead, top of my head and each temple. Took painkillers which didn''t clear it fully but enough to get some sleep. Woke in the middle of the night, headache was back, took painkillers and went back to sleep. For the next three days I had a low grade headache in the same areas, I took mild painkillers and managed to sleep through the night. The part of the headache at each temple also feels like there''s a rod going from temple, behind my eyes, to my other temple. I need to blink more often and my right eye is experiencing slight blurriness in the center of my vision. It''s been 18 days and I still have the headache and eye issue.


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