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

This is VAERS ID 1240163



Case Details

VAERS ID: 1240163 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-08
Onset:2021-04-19
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 RA / SYR

Administered by: Pharmacy       Purchased by: ?
Symptoms: Pyrexia, Rash
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Albuterol
Current Illness: None
Preexisting Conditions: Athsma
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Minor fever 48 hours post injection; acne-like rash across upper back and shoulders 11 days post-injection. Rash almost gone 14 days post-injection.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1240163


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