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From the 6/4/2021 release of VAERS data:

This is VAERS ID 1220530



Case Details

VAERS ID: 1220530 (history)  
Form: Version 2.0  
Age: 56.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-10
Onset:2021-04-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Abdominal discomfort, Abdominal pain upper, Chills, Dyspnoea, Fatigue, Feeling abnormal, Headache, Lethargy, Nausea, Pain, SARS-CoV-2 test
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Dementia (broad), Gastrointestinal perforation, ulcer, haemorrhage, obstruction non-specific findings/procedures (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Hypoglycaemia (broad), COVID-19 (broad)

Life Threatening? No
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: 1). ESTADIOL 0.05mg every day/transdermal patch. 2). NORETHINDRONE 2.5mg once daily. 3). AMBIEN 5-10mg at bedtime. 4). SERTRALINE HCL 100mg once a day. 5). VITAMIN D 125mcg/5000 IU once a day. 6). CQ 10 100 mg once a day. 7). LYSINE 1000 mg
Current Illness: NONE
Preexisting Conditions: NONE
Allergies: NONE
Diagnostic Lab Data: Rapid Covid test at Pharmacy at 5:15 pm on April 16, 2021. No results as of this time
CDC Split Type:

Write-up: Severe headache at approximately 3:330 am on Sunday April 11th, took two extra strength excedrin, (day after vaccine). didnt help much. Stomach pain started on Monday 4/12. nausea, felt like I was in a fog, very very tired. Called primary on Tuesday the 13th and was instructed to go to ER. Waited 8 hours and was unable to see MD for another 10 hours due to ER was 20 hours behind. I left and continue to have stomach discomfort, nausea, headache, chills, body aches, shortness of breath on exertion, lethargy, and brain fog.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1220530


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