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

This is VAERS ID 1247075



Case Details

VAERS ID: 1247075 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-04-01
Onset:2021-04-12
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808980 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Diverticulitis, Scan abdomen abnormal
SMQs:, Retroperitoneal fibrosis (broad), Malignancy related therapeutic and diagnostic procedures (narrow), Gastrointestinal nonspecific inflammation (broad)

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: enalapril, celexa, ASA
Current Illness:
Preexisting Conditions: Depression HTN
Allergies: None
Diagnostic Lab Data: CT consistent with acute sigmoid diverticultitis
CDC Split Type:

Write-up: Patient diagnosed via CT scan with acute diverticulitis about 4/14/21


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1247075


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