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From the 4/30/2021 release of VAERS data:

This is VAERS ID 1130008



Case Details

VAERS ID: 1130008 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Female  
Location: Wisconsin  
Vaccinated:2021-03-22
Onset:2021-03-24
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-03-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Dizziness, Hyperhidrosis, Nausea, Pallor
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: none
CDC Split Type:

Write-up: 5 minutes following vaccination, patient became pale, sweaty, dizzy, and light headed. Vitals noted to be: Bp 88/60, P 100, R 16 no distress. Patient laid down on cot and given ice pack on neck. Patient also reported having nausea and abdominal cramps. Patient monitored for half hour. Color improved and Bp noted to improve to 110/66. Patient drove home by father.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1130008


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