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

This is VAERS ID 1133592



Case Details

VAERS ID: 1133592 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-25
Onset:2021-03-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 LA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Chest discomfort, Chest pain
SMQs:, Anaphylactic reaction (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Estrodial
Current Illness:
Preexisting Conditions: Atrial Septal Aneurysm
Allergies: NKDA
Diagnostic Lab Data:
CDC Split Type:

Write-up: received J&J vaccine. after observation period EE left. EE returned at 1124 after 5 minutes to report chest pain / tightness. IMT called for at 1125. Initial Vitals taken . 138/63 P 78 Spo2 100. IMT arrived at 1132. second set of vitals taken 132/72 P 67 Spo2 100. IMT assessed EE. EE declined transport. EE electing to remain and be monitored longer. Next set of vital 108/73 P 60 SPo2 99 at 1145.


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