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From the 9/3/2021 release of VAERS data:

This is VAERS ID 1417939



Case Details

VAERS ID: 1417939 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Texas  
Vaccinated:2021-06-15
Onset:2021-06-20
   Days after vaccination:5
Submitted: 0000-00-00
Entered: 2021-06-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808986 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Pain in extremity, Peripheral swelling
SMQs:, Cardiac failure (broad), Angioedema (broad), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: LISINOPRIL 40 MG BIKTARVY 50-200 MG TRICOR 145 MCG OMEGA 3 1000 CAPSULE ERGOCALICIFEROL 50000 IU TABLET
Current Illness: HYPERTENSION, HIGH CHOLESTEROL, HIV, VITAMIN D DIFIECIENY, ATOPIC DERMATITIS , HYPERTRIGLYCERIDEMIA, BILATERAL FOOT PAIN, BILATERAL TINEA PEDIS, SOFT TISSUE MASS, ERECTILS DYSFUCTION, OBESITY NO DIAGONOSIS ON AXIS 1
Preexisting Conditions: HIV, HYPERTENSION
Allergies: NKDA
Diagnostic Lab Data: Patient was sent to emergency room for further evaluation and treatment if needed.
CDC Split Type:

Write-up: Patient reported pain and swelling in left leg 5 days after receiving the Janssen vaccine. Patient was seen in clinic for symptoms and was evaluated by PCP.


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