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

This is VAERS ID 1177951



Case Details

VAERS ID: 1177951 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Male  
Location: Illinois  
Vaccinated:0000-00-00
Onset:2021-03-28
Submitted: 0000-00-00
Entered: 2021-04-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Culture stool, Diarrhoea, Nausea
SMQs:, Acute pancreatitis (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow)

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: PENICILLIN VK
Current Illness: Abstains from alcohol; Abstains from recreational drugs; Food allergy; Latex allergy; Non-smoker
Preexisting Conditions: Medical History/Concurrent Conditions: Blind; Colostomy; Craniopharyngioma benign (Patient took medications.); Neoplasm of unspecified nature of brain; Rectal fissure; Shunt malfunction NOS
Allergies:
Diagnostic Lab Data: Test Date: 20210328; Test Name: Stool culture; Result Unstructured Data: Negative for C-Diff; Test Date: 20210328; Test Name: Blood test; Result Unstructured Data: Negative for C-Diff
CDC Split Type: USJNJFOC20210401297

Write-up: DIARRHEA; NAUSEA; This spontaneous report received from a patient concerned a 55 year old male. The patient''s weight was 390 pounds, and height was 68 inches. The patient''s past medical history included benign cranial pherengioma, legally blind, history of multiple shunt revision., sigmoid colostomy, rectal fissure, and neoplasm of unspecified nature of brain, and concurrent conditions included latex allergy, allergy to strawberry, non alcohol user, non smoker, and non drug user. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, intramuscular) dose, start therapy date were not reported for prophylactic vaccination at right deltoid on approximately 26/Mar/2021. The batch number was not reported and has been requested. Concomitant medications included phenoxymethylpenicillin potassium. On 28-MAR-2021, the subject experienced diarrhea. On 28-MAR-2021, the subject experienced nausea. Laboratory data included: Blood test (NR: not provided) Negative for C-Diff, and Stool culture (NR: not provided) Negative for C-Diff. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from diarrhea, and nausea on 29-MAR-2021. This report was non-serious.; Sender''s Comments: V0: Medical assessment comment not required as per standard procedure, since case assessed as non serious


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