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

This is VAERS ID 1212154

Case Details

VAERS ID: 1212154 (history)  
Form: Version 2.0  
Age: 40.0  
Sex: Female  
Location: Connecticut  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805022 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Back pain, COVID-19, Chest X-ray, Chills, Computerised tomogram, Cough, Dyspnoea, Fatigue, Headache, Nausea, Oropharyngeal pain, Pain, Pain in extremity, SARS-CoV-2 test positive, Tremor
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Retroperitoneal fibrosis (broad), Parkinson-like events (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Tendinopathies and ligament disorders (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: partially clotted varicose vein in upper right thigh
Allergies: amoxicillan, penicillan
Diagnostic Lab Data: 3/19/21 - chest x-ray, CT scan at hospital
CDC Split Type:

Write-up: Within 4 hours of receiving the vaccine on 3/9/21 I felt exhaustion, body aches, chills and headache. About 30 hours later I started to experience extreme leg pain/tremors, severe nausea and an unrelenting headache, lower back pain and continued chills. 6 days after receiving the vaccine (3/15/21) I tested positive for Covid-19 and the symptoms worsened. 8 days after receiving the vaccine I developed a cough and sore throat and trouble breathing. 10 days after receiving the vaccine I went to the emergency room (3/19/21) and received a chest x-ray and diagnosed with covid pneumonia and given antibiotics to treat along with a CT scan. Symptoms started to subside about 2 weeks after receiving the vaccine, although to this day I am still troubled with a lingering headache and constant fatigue. Throughout the duration I relied on Tylenol and Motrin. At the hospital I was prescribed indomethacin and ondansetron for pain and nausea.

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