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

This is VAERS ID 1693540

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Case Details

VAERS ID: 1693540 (history)  
Form: Version 2.0  
Age: 71.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-10
Onset:2021-09-10
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / SYR

Administered by: Private       Purchased by: ?
Symptoms: Chills, Gait disturbance, Headache, Pain, Pyrexia, Tremor
SMQs:, Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Noninfectious encephalopathy/delirium (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Flu vaccine at age of 12 yrs. of age, similar symptoms.
Other Medications: Metoprolol Tylenol, isosorbide mononitrate, Rosuvastatin, montelukast, acyclovir
Current Illness: None
Preexisting Conditions: micro vascular coronary disease recently diagnosed.
Allergies: Flu vaccines, caffeine, penicillin, fish, dust
Diagnostic Lab Data: None made.
CDC Split Type:

Write-up: Within 12 hours had severe chills with body shaking tremors, fever of over 100 degrees, body aches, head ache and difficult to walk. Body shakes lasted two hours until the Tylenol kicked in. Body aches and head ache lasted another 10 hours or so.


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