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

This is VAERS ID 1464482



Case Details

VAERS ID: 1464482 (history)  
Form: Version 2.0  
Age: 44.0  
Sex: Male  
Location: Idaho  
Vaccinated:2021-05-28
Onset:2021-07-03
   Days after vaccination:36
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 AR / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray normal, Chills, Cough, Dyspnoea, Electrocardiogram normal, Hypoaesthesia, Influenza like illness, Influenza virus test negative, Myalgia, Nasal congestion, SARS-CoV-2 test negative
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Tendinopathies and ligament disorders (broad), COVID-19 (broad), Sexual dysfunction (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Neosporin
Diagnostic Lab Data: Flu test negative Covid test negative Chest X-ray clear EKG normal
CDC Split Type:

Write-up: Flu like symptoms. Stuffy nose, cough, shortness of breath, muscle aches, chills. Numbness in the whole right arm from shoulder to fingertips.


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