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

This is VAERS ID 1493650



Case Details

VAERS ID: 1493650 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Male  
Location: New Hampshire  
Vaccinated:2021-05-02
Onset:2021-07-08
   Days after vaccination:67
Submitted: 0000-00-00
Entered: 2021-07-22
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / UNK UN / SYR

Administered by: Other       Purchased by: ?
Symptoms: Anosmia, Back pain, COVID-19, Cough, Fatigue, Headache, Malaise, Oxygen saturation decreased, Pain, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Taste and smell disorders (narrow), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Respiratory failure (broad), Infective pneumonia (broad), Opportunistic infections (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Multi-Vitamin Concerta
Current Illness: Tick Bite; Concern about Lyme disease carrier (deer tick). Had to visit the clinic and revived single does of antibiotic. 1 week prior to vaccine
Preexisting Conditions: non
Allergies: non
Diagnostic Lab Data: Tested Positive for Covid19 on 07/08/2021. Suspected Delta Variant PCR test
CDC Split Type:

Write-up: Tested Positive for Covid19 on 07/08/2021. Suspected Delta Variant Had Covid19 Symptoms, including headache, body pains, Severe lower back pain, Loss of smell, Low oxygen levels (83%), persistent cough, fatigue- Lasted 10days Recovered, but persistent cough, mild headaches and mild fatigue


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