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

This is VAERS ID 1694569

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Case Details

VAERS ID: 1694569 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-03-11
Onset:2021-08-01
   Days after vaccination:143
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / UNK LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Blood test, COVID-19, Computerised tomogram thorax, Cough, Dyspnoea, Headache, Human rhinovirus test positive, Muscle spasms, Pneumonia, Rhinovirus infection, SARS-CoV-2 test positive, X-ray
SMQs:, Anaphylactic reaction (broad), Dystonia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
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: Sentraline 50 mg
Current Illness: N/A
Preexisting Conditions: Since Covid positive, battling double pneumonia
Allergies: Nuts
Diagnostic Lab Data: August 4, xray August 4, blood tests September 1, lung CT September 3, blood tests, xrays September 21-another lung CT scan scheduled
CDC Split Type:

Write-up: Coughing, headache, severe leg cramps, trouble breathing. Double pneumonia, Covid 19, & Rhino virus. X-rays, lung CT scan, blood tests, 3 different antibotics, breathing treatments, cough & cold meds.


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