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From the 5/7/2021 release of VAERS data:

This is VAERS ID 1129904



Case Details

VAERS ID: 1129904 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-24
Onset:2021-03-24
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / UNK RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Dizziness, Tremor, Visual impairment
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (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: albuterol (PROVENTIL HFA;VENTOLIN HFA;PROAIR HFA) inhaler ALPRAZolam (XANAX) 0.5 MG tablet amLODIPine (NORVASC) 5 MG tablet atorvastatin (LIPITOR) 20 MG tablet busPIRone (BUSPAR) 5 MG tablet diphenhydrAMINE (BENADRYL) 25 mg capsul
Current Illness: none
Preexisting Conditions: Essential hypertension, benign (*) Sleep apnea Migraine headache (*) Asthma (*) Pure hyperglyceridemia (*) Generalized anxiety disorder (*) Controlled type 2 diabetes mellitus with renal manifestation (*) Hyperlipidemia Proteinuria Controlled type 2 diabetes mellitus without complication (*) MDD (major depressive disorder), recurrent severe, without psychosis (*) Panic disorder without agoraphobia (*)
Allergies: CodeineHives Contrast [Iodinated Contrast Media]Hives Darvon [Propoxyphene]Hives ErythromycinNausea And Vomiting Hydrocodone PiroxicamOther (See Comments) Garamycin [Gentamicin]Rash Monistat 1 [Tioconazole]Rash PropranololRash Sulfa (Sulfonamide Antibiotics)Rash
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient experienced lightheadedness, spots in vision, and shakiness approximately 30 mins after receiving the vaccine. Was monitored for 25 mins with no resolution in symptoms and was sent to the emergency room for additional evaluation.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1129904


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