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

This is VAERS ID 1136915

Case Details

VAERS ID: 1136915 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Georgia  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Public       Purchased by: ?
Symptoms: Dyspnoea, Heart rate increased, Paraesthesia, Pruritus
SMQs:, Anaphylactic reaction (narrow), Peripheral neuropathy (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Cardiomyopathy (broad), Hypersensitivity (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (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: none reported
Current Illness: None Reported
Preexisting Conditions: None Reported
Allergies: IVP Dye; Shellfish
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Complaint of itching and tingling around neck, ears, and face. Felt as if had rapid heart rate and short of breath. Blood Pressure stable at 150/85 and 158/90 and Heartrate 66-80/min. O2 Sat 88% when EMS arrived. Epinephrine .5mg epinephrine administered and Benadryl 50 mg IM; O2 at 2 L NC. EMS called and transported to Medical Center. Stable at time of departure with EMS at 9:34. Reaction started within 15 minutes of receiving vaccine.

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