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

This is VAERS ID 1230057



Case Details

VAERS ID: 1230057 (history)  
Form: Version 2.0  
Age: 68.0  
Sex: Male  
Location: California  
Vaccinated:2021-04-07
Onset:2021-04-11
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 UN / UN

Administered by: Private       Purchased by: ?
Symptoms: Abdominal X-ray, Abdominal pain, Full blood count, Headache, Pain, Urine analysis, Vision blurred
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Lens disorders (broad), Retinal 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? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: N/A
Allergies: N/A
Diagnostic Lab Data: Labs : routine chemistry, CBC differential, UA Macroscopic, XR acute abdomen series ( 4/14/2021)
CDC Split Type:

Write-up: Headache, diffuse abdominal pain , recent blurred vision lasting 1 week


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1230057


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