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

This is VAERS ID 1484841



Case Details

VAERS ID: 1484841 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-03-23
Onset:2021-07-18
   Days after vaccination:117
Submitted: 0000-00-00
Entered: 2021-07-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK UN / -

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray abnormal, Condition aggravated, Confusional state, Cough, Infusion, Lung consolidation
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypoglycaemia (broad), Infective pneumonia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: unknown
Current Illness: unknown
Preexisting Conditions: histroy artery disease, Diabetes type 2, gerd, chronic back pain,and confusion
Allergies: Pollen
Diagnostic Lab Data:
CDC Split Type:

Write-up: DId not know body site of injection Worsening confusion, exposed at a birthday party daughter wanted patient to come in / patient was very cofused per daughter patient is poor historian dry cough at exam considelation on right lower love on chest x-ray patient did an infusion on 7/12 casirivimab-imdevimab patient was admited on 7/18/2021 to hospital.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1484841


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