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From the 5/14/2021 release of VAERS data (an older release, current is 11/26/2021):

This is VAERS ID 1134203

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Case Details

VAERS ID: 1134203 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Florida  
Vaccinated:2021-03-06
Onset:2021-03-17
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: CSF glucose normal, CSF lymphocyte count normal, CSF neutrophil count increased, CSF protein increased, CSF white blood cell count, Computerised tomogram head normal, Computerised tomogram spine, Guillain-Barre syndrome, Lumbar puncture
SMQs:, Peripheral neuropathy (narrow), Guillain-Barre syndrome (narrow), Demyelination (narrow), Immune-mediated/autoimmune disorders (narrow)

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: None
Current Illness: none
Preexisting Conditions: Prostate cancer Esophageal reflux disease Hypercholesterolemia
Allergies: None
Diagnostic Lab Data: Normal Brain Ct scan Normal Spine Ct scan Lumbar puncture: 4wbc, 12 % neutrophile, 76 % lymphocytes; Protein: 162; Glucose: 61
CDC Split Type:

Write-up: Guillan-Barre syndrome


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