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From the 11/12/2021 release of VAERS data:

This is VAERS ID 1693790

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Case Details

VAERS ID: 1693790 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Male  
Location: Wisconsin  
Vaccinated:2021-09-10
Onset:2021-09-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-12
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Dyspnoea, Fatigue, Feeling abnormal, Nausea, Pain, Pneumonitis, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (narrow), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuteral, duoneb, symbicort, delta 8, kratom, percocet
Current Illness: Had teeth removed Wednesday September 8th, no other illnesses was in perfect health other then having to have two painful teeth extracted
Preexisting Conditions: Asthma
Allergies: Sulfa, cephelexon, ibuprofen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Fever, fatigue, mental fogginess, difficulty breathing due to inflammation in my lungs, random sharp pain all over body, nausea. Treated by steroids and multiple duonebs at the er. At home I had to take 3 albuteral and 3 duonebs as well as 4 extra doses of my symbicort to try to control my breathing and get out under control


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