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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1761343

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Case Details

VAERS ID: 1761343 (history)  
Form: Version 2.0  
Age: 42.0  
Sex: Male  
Location: Washington  
Vaccinated:2021-10-04
Onset:2021-10-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1822809 / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Confusional state, Influenza like illness, Insomnia, Night sweats
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypoglycaemia (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? No
Previous Vaccinations:
Other Medications: Vitamin c and D3
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: Erythamiacin
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Extreme flu like symptoms, loss of sleep, confusion, night sweats, chills


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