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

This is VAERS ID 1195158

Case Details

VAERS ID: 1195158 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Texas  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

Administered by: Senior Living       Purchased by: ?
Symptoms: Blood urea normal, Chills, Diarrhoea, Differential white blood cell count normal, Dizziness, Fatigue, Headache, Lymphocyte percentage decreased, Metabolic function test, Neutrophil count increased, Platelet count normal, Rash, Red blood cell count decreased, Tachycardia, Vasculitis
SMQs:, Anaphylactic reaction (broad), Haematopoietic erythropenia (narrow), Haematopoietic leukopenia (broad), Haemorrhage laboratory terms (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Vasculitis (narrow), Hypersensitivity (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Dehydration (broad), Immune-mediated/autoimmune disorders (narrow)

Life Threatening? Yes
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: n/a
Current Illness: n/a
Preexisting Conditions: Asthma
Allergies: Penicillin
Diagnostic Lab Data: CBC (04/09/21), WBC: 10.0 , RBC: 4.05 (low), PLT: 362 (high), NEUT %: 77.8 (high), LYMPH %: 14.0 (low), NEUT #: 7.79 (high), CMP (04/09/21), BUN: 19 (high)
CDC Split Type:

Write-up: Tachycardia, Fatigue, Dizziness, Headache, Diarrhea, Chills, Vasculitis, Face Rash.

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