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

This is VAERS ID 1591510

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Case Details

VAERS ID: 1591510 (history)  
Form: Version 2.0  
Age: 35.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-08-06
Onset:2021-08-08
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-08-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Asthenia, Blood creatine phosphokinase, Blood test, C-reactive protein, Chest pain, Computerised tomogram, Electrocardiogram abnormal, Fatigue, Headache, Hypoaesthesia, Magnetic resonance imaging, Muscular weakness, Pain, Pain in extremity, Pericarditis, Pyrexia, Red blood cell sedimentation rate, Scan with contrast
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Chronic kidney disease (broad), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), Sexual dysfunction (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fiber supplement
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Sulfa antibiotics
Diagnostic Lab Data: 8/18 CT Scan with contrast, MRI, EKG, Blood work, and physical examination ruled out stroke. 8/20 Follow-up visit with GP performed C-Reactive Protein, CK Total, and Erythrocyte Sedimentation Rate blood work. Results pending. Additional EKG performed. EKG showed abnormality consistent with Pericarditis. Began treatment as prescribed.
CDC Split Type:

Write-up: Initial pain and fever on 8/7/2021. Pain in left arm turned into numbness. Numbness extended down the arm and severe headaches persisted. Weakness in muscles including legs developed after about 5-6 days. Overall, extreme exhaustion and weakness after the first week. Chest pain developed. On 8/18, numbness on the left side of my face appeared. All other symptoms previously noted were present.


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