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

This is VAERS ID 1700857

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Case Details

VAERS ID: 1700857 (history)  
Form: Version 2.0  
Age: 27.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-28
Onset:2021-09-14
   Days after vaccination:139
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Angiogram cerebral normal, Drug screen negative, Full blood count normal, Hypoaesthesia, Hypoaesthesia oral, Laboratory test normal, Magnetic resonance imaging head normal, Muscular weakness, SARS-CoV-2 test negative, Scan with contrast normal, Tongue movement disturbance
SMQs:, Rhabdomyolysis/myopathy (broad), Peripheral neuropathy (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), COVID-19 (broad), Sexual dysfunction (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, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: 9/14/21 CBC and chem panel - all within normal 9/14/21 SARS-CoV-2 PCR - negative 9/14/21 Drug of Abuse test (Ethanol, Barbituate, Benzodiazepine, TCA, Phenytoin, Acetaminophen, Salicylate, Cannabinoid, Cocaine, Opiate, PCP, Methamphetamine) - All negative 9/14/21 CT Angio Head with IV contrast and whole brain perfusion - No acute intracranial large vessel occlusion, no focal perfusion deficit 9/15/21 MRI of the brain without contrast - Negative MRI of brain without contrast
CDC Split Type:

Write-up: 28 year old male with no past medical history who presents to the hospital with acute onset right arm and leg weakness and numbness, and weakness and numbness of the tongue, given alteplase for concern for stroke, now returned to baseline neuro function with no deficits.


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