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

This is VAERS ID 1249238



Case Details

VAERS ID: 1249238 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: California  
Vaccinated:0000-00-00
Onset:2021-04-12
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Headache, Heart rate increased, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Glaucoma (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypoglycaemia (broad), Dehydration (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:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210427607

Write-up: FAST HEARTBEAT; BLURRED VISION IN LEFT EYE; LIGHTHEADEDNESS; PRESSURE IN THE HEAD, HEADACHE; This spontaneous report received from a consumer concerned a male of unspecified age. The patient''s weight, height, and medical history were not reported. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, administered on 05-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 12-APR-2021, the subject experienced fast heartbeat. On 12-APR-2021, the subject experienced blurred vision in left eye. On 12-APR-2021, the subject experienced lightheadedness. On 12-APR-2021, the subject experienced pressure in the head, headache. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from fast heartbeat, blurred vision in left eye, and lightheadedness on 12-APR-2021, and was recovering from pressure in the head, headache. This report was non-serious.; Sender''s Comments: V0:Medical assessment comment not required as per standard procedure as case assessed as non serious.


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