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

This is VAERS ID 1440543



Case Details

VAERS ID: 1440543 (history)  
Form: Version 2.0  
Age: 73.0  
Sex: Male  
Location: Missouri  
Vaccinated:2021-03-09
Onset:2021-06-29
   Days after vaccination:112
Submitted: 0000-00-00
Entered: 2021-07-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 - / -

Administered by: Private       Purchased by: ?
Symptoms: COVID-19, Cough, Dyspnoea, Myalgia, Oropharyngeal pain, Pyrexia, SARS-CoV-2 test positive
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Tested + for COVID 6/29/21.
CDC Split Type:

Write-up: Developed symptoms of COVID on 6/24/21, cough, shortness of breath, sore throat, myalgias, and a fever.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1440543


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