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

This is VAERS ID 1771636

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Case Details

VAERS ID: 1771636 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-08-17
Onset:2021-10-01
   Days after vaccination:45
Submitted: 0000-00-00
Entered: 2021-10-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1820095 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Rash
SMQs:, Anaphylactic reaction (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: plavxi, lipitor, ASA, metoprolol, metformin, famotidine
Current Illness: none
Preexisting Conditions: DM, MI with stents, HLD, HTN
Allergies: none
Diagnostic Lab Data:
CDC Split Type:

Write-up: rash, 10/2021. does not feel right since the vaccine


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