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

This is VAERS ID 1248849



Case Details

VAERS ID: 1248849 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Michigan  
Vaccinated:2021-04-08
Onset:2021-04-19
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Headache, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (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? No
Hospitalized? No
Previous Vaccinations:
Other Medications: None, other than tea (ginger, cinnamon, black tea)
Current Illness: None
Preexisting Conditions: None
Allergies: None known
Diagnostic Lab Data: None. Does not have insurance or care provider. Will look for care that is free.
CDC Split Type:

Write-up: Severe headache x 5 days affecting ability to see and complete daily activities


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1248849


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