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

This is VAERS ID 1213198



Case Details

VAERS ID: 1213198 (history)  
Form: Version 2.0  
Age: 20.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-12
Onset:2021-04-12
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK LA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Back pain, Headache, Urethral pain, Vomiting
SMQs:, Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (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: cranberry pill Reclipsen
Current Illness:
Preexisting Conditions: As per patient - adolescent epilepsy
Allergies: Amoxicillin
Diagnostic Lab Data:
CDC Split Type:

Write-up: Headache, vomiting, back pain, urethral discomfort


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1213198

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