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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1465771

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Case Details

VAERS ID: 1465771 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Male  
Location: California  
Vaccinated:2021-05-14
Onset:2021-05-25
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-07-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 043A21A / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Arthralgia, Atrial enlargement, Bundle branch block right, Chest pain, Dyspnoea, ECG signs of myocardial ischaemia, Echocardiogram abnormal, Electrocardiogram ST segment abnormal, Electrocardiogram T wave abnormal, Exercise tolerance decreased, Fatigue, Headache, Heart rate irregular, Hyperhidrosis, Impaired work ability, Loss of consciousness, Malaise, Myocarditis, Nausea, Palpitations, Pericarditis
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Myocardial infarction (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Conduction defects (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Cardiac arrhythmia terms, nonspecific (narrow), Other ischaemic heart disease (narrow), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad), Chronic kidney disease (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Hypokalaemia (broad), Immune-mediated/autoimmune disorders (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Metformin 500mg; Rinvoq 15mg Rosuvastin 10mh Nexletol180mg Farxia 10mg Trulicity 1.5 Vit C Vit D Zinc Vascepa
Current Illness: Diabetes
Preexisting Conditions: Diabetes Wolfe Parkinson white syndrome Arthritis
Allergies: Pecans Banana Olive Trees Walnuts
Diagnostic Lab Data: EKG -Bilateral Enlargement, Incomplete right bundle branch block ,ST and T wave Inferior Ischemia Echo- Myocarditis and Pericarditis
CDC Split Type:

Write-up: I did not feel well for several days following the injection. I was tired and had a headache. However as the days went bye I stopped exercising and did not feel like working or even leaving the house. On the night of May 24 I began to have the worst headache of my life, my heart was beating irregular. By the morning of the 25th I got up and passed out. I was sweating, heart pounding, nauseous, chest pain, shortness of breath, pain in my shoulder blades.


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