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

This is VAERS ID 1694059

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Case Details

VAERS ID: 1694059 (history)  
Form: Version 2.0  
Age: 60.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-03-11
Onset:2021-08-23
   Days after vaccination:165
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 805029 / 1 LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, COVID-19, Computerised tomogram, Dyspnoea, Magnetic resonance imaging, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: metformin
Current Illness: none
Preexisting Conditions: diabetes, COPD
Allergies: none
Diagnostic Lab Data: MRI, CAT scan, blood work- I do not know the results Covid test- positive
CDC Split Type: vsafe

Write-up: I was at home in bed and I was very lucky to wake up. I told my wife I needed medical attention right away because I could not breathe. We got in the car and drove to the hospital. They did a whole bunch of tests. MRI, CAT scan, blood work, Covid test. I do not know the results of the tests, only the Covid test, which was positive. Once I was admitted they did 2 treatments through IV. I was only there for one day and a half. They gave me a steroid for 5 days.


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