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

This is VAERS ID 1133281

Case Details

VAERS ID: 1133281 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Maine  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 4 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Anxiety, Immediate post-injection reaction, Tachypnoea
SMQs:, Anaphylactic reaction (broad), Asthma/bronchospasm (broad), Eosinophilic pneumonia (broad), Hypersensitivity (narrow), Respiratory failure (broad), Hypoglycaemia (broad), Infective pneumonia (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: Atenolol, Losartan, Valium, Zyrtec, acetazolamide, Baclofen
Current Illness: Mast cell activation
Preexisting Conditions: Mast cell activation, SVT, dystonia,
Allergies: Compazine
Diagnostic Lab Data: None
CDC Split Type:

Write-up: History of mast cell activation and patient stated she "usually has reactions to everything." Patient experienced tachypnea and anxiety immediately following administration of dose of vaccine. SxS persisted for approximately 45 minutes. EMS was called to the scene to evaluate patient. symptoms decreased after 45 minutes and patient stated she did not want to go to the hospital. Reference EMS Incident for full PCR. Advised patient to contact her primary care physician for follow up.

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