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

This is VAERS ID 1136967



Case Details

VAERS ID: 1136967 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-03-25
Onset:2021-03-25
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / SYR

Administered by: Public       Purchased by: ?
Symptoms: Chills, Headache, Hot flush, Nausea, Retching
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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: Lisinopril hctz One a day men''s 50+
Current Illness: None
Preexisting Conditions: High blood pressure
Allergies: Coconut
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Headache 6 hours after shot lasting 24 hours Chills and hot flashes unabated Nausea and dry heaves


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