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

This is VAERS ID 1212002



Case Details

VAERS ID: 1212002 (history)  
Form: Version 2.0  
Age: 30.0  
Sex: Female  
Location: Maryland  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 042A21A / N/A RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Decreased appetite, Fatigue, Hypersomnia, Injection site erythema, Pain, Pain in extremity, Platelet count normal, Restless legs syndrome, Seizure like phenomena, Vomiting
SMQs:, Acute pancreatitis (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Extravasation events (injections, infusions and implants) (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Depression (excl suicide and self injury) (broad), Tendinopathies and ligament disorders (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? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: flu vaccine
Other Medications: Yaz- birht control vitamin B12 vitamin D salt pills multivitamins one a day
Current Illness: POTS, MCAS, EDS, chronic fatigue, dysautonomia
Preexisting Conditions: POTS, MCAS, EDS, chronic fatigue, dysautonomia
Allergies: penicillin amoxicillin fentanyl Sudafed dilaudid
Diagnostic Lab Data: please contact the physician or hospital for details. We were not provided a list of blood work. We did ask about platelets and were told the level was "normal"
CDC Split Type:

Write-up: my daughter, 30 year old, on disability with POTS, MCAS, EDS, dysautonomia, received the JJ COVID vaccine at 1:30 PM on 4/9/2021.. She started vomiting 20 minutes after the vaccine was administered and the pharmacist said it was because she was anxious and has not eaten much. We went home, she was very tired and slept most of the afternoon. At 6 PM she started vomiting again. It continued till 10:30 PM when she could not drink anything. We went to the hospital where she exhibited what looked like a seizure in the waiting room and was admitted to the hospital for observation. Discharged 4/10/2021 evening. 4/11/2021 exhibited restless leg syndrome, could not sit, lay down, whole body aches. 4/12/2021 extremely sore arm, could not move it without pain. Area of injection looks read but not hot and no swelling.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1212002

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