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

This is VAERS ID 1142457

Case Details

VAERS ID: 1142457 (history)  
Form: Version 2.0  
Age: 58.0  
Sex: Female  
Location: California  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805029 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Atrial fibrillation, Cardiac monitoring, Electrocardiogram, Presyncope
SMQs:, Anticholinergic syndrome (broad), Supraventricular tachyarrhythmias (narrow), Hypotonic-hyporesponsive episode (broad), Hypoglycaemia (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: omeprazole atovastatin coreg prednisone tylenol colace renvela
Current Illness: congestive heart failure ovarian cancer hypertension malignant ascites
Preexisting Conditions: systemic lupus end stage renal disease on hemodialysis
Allergies: penicillin sulfa codeine
Diagnostic Lab Data: ekgs cardiac monitoring
CDC Split Type:

Write-up: near syncopal episode and new onset of rapid atrial fibrillation

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