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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1100735

Case Details

VAERS ID: 1100735 (history)  
Form: Version 2.0  
Age: 63.0  
Sex: Female  
Location: New York  
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-03-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Rash, Rash pruritic, Vasculitis
SMQs:, Anaphylactic reaction (broad), Vasculitis (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Yes
Current Illness: No
Preexisting Conditions: Chronic nerve pelvic pain and bowel dysfunction following hysterectomy, esophageal fungus causing heartburn due to inability to produce saliva following implantation of intrathecal morphine pump in 2009,
Allergies: Allergic rash to one or two of my pain meds. Take monthly Xolaire shot and antihistamines
Diagnostic Lab Data: Went to my allergist. He was going to send me for tests. However, after the visit, my antihistamines wore off and the rash became itchy. My dr told me to double up on my antihistamines and hold off going for the tests. I had to use an Epi pen that evening or the next day. Hi he rash has subsided and faded. Is barely visible.
CDC Split Type:

Write-up: I developed a vasculitis rash mostly on my lower right leg. I had a tiny rash of he evening before the shot. That was a Thursday. The shot was Friday night. Monday evening I had a huge rash on my lower right leg and a very tiny rash on my lower left leg.

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