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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1168000

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Case Details

VAERS ID: 1168000 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: New York  
   Days after vaccination:8
Submitted: 0000-00-00
Entered: 2021-04-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Coagulation factor increased, Diarrhoea, Dyspnoea, Gait inability, Headache, Hypoaesthesia oral, Laboratory test abnormal, Musculoskeletal stiffness, Myalgia, Pain, Paraesthesia oral, Pericardial effusion, Pericarditis, Pyrexia, SARS-CoV-2 test negative, Swelling
SMQs:, Rhabdomyolysis/myopathy (broad), Anaphylactic reaction (narrow), Angioedema (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Pseudomembranous colitis (broad), Dystonia (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Haemodynamic oedema, effusions and fluid overload (narrow), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Chronic kidney disease (broad), Arthritis (broad), Noninfectious diarrhoea (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (broad), COVID-19 (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, 11 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Synthroid.
Current Illness: None.
Preexisting Conditions: Hashimoto''s thyroid disease.
Allergies: Doxycycline.
Diagnostic Lab Data: Multiple with the different admissions. Her clotting #''s were high and off the charts and the other #''s are also not good.
CDC Split Type:

Write-up: She had the vaccine and within 1 minute she had tingling in her tongue and numbness that went away immediately. She did not have any other symptoms until 8 days later when she had 104 fever, could not walk, had stiffness in all of her muscles and aching, diarrhea. They went to the doctor office and he did a COVID test that came back negative. The fever still continued and her husband took her to the hospital on Tuesday 3/16/21. They ran fluids on her and at the end of the day they said she was okay to go home. The next day the fever started again and he ended up calling an ambulance to take her to the hospital. She went to Hospital on 3/16, who took her to another Hospital. They sent her home about 4 days later and said that her symptoms were from the vaccine. He called and he filed a report with them. They sent her home the next day, got another high fever, and her husband took her to the ER at again that evening. She had high fever, extremes aches and pains and headaches. They kept her a couple of days and then released her again. She was home for a couple of days and they were managing her fever as it would spike at night. She also had 8 other medications to take. She then woke up yesterday 4/4/21 with severe back pain, cannot walk real well, and her husband called the ambulance again. Now she has swelling in her heart, swelling around her heat and not breathing very well, and 104 fever and getting progressively worse They said that she now has pericarditis and pericardial effusion and are going to release the fluid today. She is still in the hospital.

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