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

This is VAERS ID 1696941

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Case Details

VAERS ID: 1696941 (history)  
Form: Version 2.0  
Age: 95.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-08
Onset:2021-08-07
   Days after vaccination:121
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, Chest X-ray abnormal, Infection, Interstitial lung disease, Pulmonary oedema, Pyrexia, Somnolence
SMQs:, Cardiac failure (narrow), Interstitial lung disease (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Immune-mediated/autoimmune disorders (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? Yes, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Furosemide, levothyroxine, lovastatin, metoprolol succinate, nitro PRN, omeprazole, miralax, raloxifene
Current Illness:
Preexisting Conditions: Barrett''s esophagus, hypertension , IBS, shingles, hypothyroid
Allergies: Dexfenfluramine
Diagnostic Lab Data: 8/7/21 Chest xray: Bilateral increased interstitial markings of uncertain etiology. Atypical infection and pulmonary edema are considerations. 8/13/21 Chest xray: same as 8/7/21
CDC Split Type:

Write-up: Came to ER with fever, generalized weakness starting on 8/7/2021. Temp of 101.9, Saturating 90s on 2L NC. Patient was drowsy and alert and oriented x 1. Received azithromycin and ceftriaxone. Admitted to the hospital. Through stay was treated with supplemental oxygen, Decadron, azithromycin, ceftriaxone.Over the course of hospitalization patient was successfully weaned off the oxygen. Had no noted fever spikes. Was breathing on room air. Finished antibiotics and steroids. Patient was taken of isolation precautions before discharge based on institutional protocols. discharged to SNF on 8/18/21


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