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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1175292



Case Details

VAERS ID: 1175292 (history)  
Form: Version 2.0  
Age: 47.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-01
Onset:2021-04-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Chest pain, Dyspnoea, Electrocardiogram, Feeling cold, Feeling hot, Headache, Nausea, Pyrexia, Somnolence, Vertigo
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Vestibular disorders (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Sprintec, zyrtec, vitamin D3, multi vitamin
Current Illness: N/A
Preexisting Conditions: Reflux Disease
Allergies: Celebrex
Diagnostic Lab Data: Blood work, ekg, chest x-ray. All results normal
CDC Split Type:

Write-up: 15 minutes after vaccination the room started spinning, felt fine after aprx 30 minutes. About an hour and a half after vaccination I had shortness of breath and chest pain. (went to ER). Had nausea at ER was given medicine. Aprx 8pm had the feeling of something hot and cold being injected into my right wrist that went through my entire body. Called 911. Paramedic stated it was the vaccine running it course and to breath through it. Next day. Little groggy, low grade fever, slight headache and shortness of breath, Saturday morning had another episode of feeling like something was being injected into my wrist. It settled at my chest. Was very painful for about 3-5 minutes. Slept rest of day. Shortness of breath. Woke up Sunday and felt 100% fine.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1175292

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