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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1091905

Case Details

VAERS ID: 1091905 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: Kansas  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Dizziness, Electrocardiogram normal, Paraesthesia
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Vestibular disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Furosemide, Lopressor, Topamax, Multivitamin, Vitamin E, Alphagan opth drops, Lumigan opth drops, Lutein, Stark Pharmacy Hormone replacement specialty compound, Trelegy inhaler
Current Illness: Ischemia, anxiety
Preexisting Conditions: unknown
Allergies: Penicillin
Diagnostic Lab Data: Pulse 120, Blood pressure 170/110, EKG - normal
CDC Split Type:

Write-up: Heart rate 120 bpm, Blood pressure 170/110, lightheaded, feeling faint, tingling, anxiety

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