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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1470657

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Case Details

VAERS ID: 1470657 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Puerto Rico  
Vaccinated:2021-04-09
Onset:2021-06-10
   Days after vaccination:62
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anal incontinence, Asthenia, Cardiopulmonary bypass, Diarrhoea, Full blood count, Guillain-Barre syndrome, Headache, Immunoglobulin therapy, Influenza virus test, Intensive care, Lumbar puncture, Mycoplasma test, Nasal congestion, Pain in extremity, Paralysis, Pyrexia, SARS-CoV-2 test, Urinary incontinence
SMQs:, Peripheral neuropathy (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Guillain-Barre syndrome (narrow), Noninfectious encephalitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Demyelination (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow), COVID-19 (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 27 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Irbesartan-Hydrochlorothiazide 150-12.5 mg
Current Illness: Hypertension
Preexisting Conditions: Hypertension
Allergies: No Known Allergies
Diagnostic Lab Data: Covid-19 Test, Influenza Test, Mycoplasma Test, Lumbar Punction (6/20/2021), CBC
CDC Split Type:

Write-up: Adverse Events: Headache, Fever, Diarrhea, Nasal Congestion, Leg Pain, Weakness, Paralysis Dx. Guillain Barre Treatment: Immunoglobulin, Sodium Chloride 0.9%, Respiratory Bypass, Oxygen Outcomes: Patient actually in Intensive Care Unit at Hospital receiving treatment. Continue with oxygen by nasal cannula, whole body paralysis with urinary and feccal incontinence (foley and diaper). Symptoms begin since June 10,2021. Admission to Hospital on June 17, 2021 to present.


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