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

This is VAERS ID 1697827

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Case Details

VAERS ID: 1697827 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-08-02
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Chills, Dry eye, Dyspnoea, Pain in extremity, Pyrexia
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Corneal disorders (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: DEJNJFOC20210918408

Write-up: DRY EYES; ABDOMINAL CRAMPS; CHILLS; PAIN IN ARM; PYREXIA; DYSPNOEA; This spontaneous report received from a consumer by a Regulatory authority (EVHUMAN Vaccines, DE-PEI-CADR2021154729) on 08-SEP-2021 and concerned a 17 year old male of unspecified race and ethnic origin. The patient''s weight was 108 kilograms, and height was 188 centimeters. No past medical history or concurrent conditions were reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Lot XE395 expiry: Unknown) dose was not reported, 1 total administered on 02-AUG-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-AUG-2021, the patient experienced dyspnoea, abdominal cramps, chills, pain in arm and pyrexia. On 03-AUG-2021, patient experienced dry eyes. On an unspecified date, the patient was hospitalized. Number of days hospitalized and discharge information was not reported. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from dyspnoea, chills, pain in arm, abdominal cramps, and pyrexia, and had not recovered from dry eyes. This report was serious (Hospitalization Caused / Prolonged).; Sender''s Comments: Are you or the affected person aware of any allergies? If yes, which? Pollen, Hay Indications regarding risk factors or underlying conditions None that I am aware of / Arm was hurting, I went home all was good, a little tired I laid myself in bed I was hot getting out from under the covers ice-cold Eyes after 8 hours dry and somewhat painful cramping during respiration when in inhale deeply Fever that has subsided but all the rest is still present


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