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

This is VAERS ID 1249404



Case Details

VAERS ID: 1249404 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-04-11
Submitted: 0000-00-00
Entered: 2021-04-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Antiphospholipid antibodies positive, Blood urine present, Headache, Protein urine present, Urine analysis, Vomiting
SMQs:, Acute renal failure (broad), Acute pancreatitis (broad), Haemorrhage terms (excl laboratory terms) (narrow), Haemorrhage laboratory terms (narrow), Systemic lupus erythematosus (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Chronic kidney disease (broad), Proteinuria (narrow), Tubulointerstitial diseases (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Immune-mediated/autoimmune disorders (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: MACROBID
Current Illness: Chronic kidney disease stage 2; Obesity; Psoriatic arthritis; Rheumatoid arthritis; Systemic lupus erythematosus; Type II diabetes mellitus
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210414; Test Name: Urinalysis; Result Unstructured Data: positive for blood, positive for protein; Test Name: Lupus anticoagulant positive; Result Unstructured Data: positive
CDC Split Type: USJNJFOC20210437769

Write-up: PROTEIN IN URINE; BLOOD IN URINE; VOMITING; HEADACHE; ABDOMINAL PAIN; This spontaneous report received from a patient concerned a 60 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included type 2 diabetes, rheumatoid arthritis, systemic lupus erythematosus, obesity, stage 2 chronic kidney disease, and psoriatic arthritis. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 041A21A expiry: UNKNOWN) dose was not reported, administered on 08-APR-2021 for prophylactic vaccination. Concomitant medications included nitrofurantoin for blood in urine, and protein in urine. On 11-APR-2021 04:00, the subject experienced abdominal pain. On 11-APR-2021 09:00, the subject experienced vomiting. On 11-APR-2021 09:00, the subject experienced headache. On 14-APR-2021, the subject experienced protein in urine. On 14-APR-2021, the subject experienced blood in urine. Laboratory data included: Urinalysis (NR: not provided) positive for blood, positive for protein. Laboratory data (dates unspecified) included: Lupus anticoagulant positive (NR: not provided) positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from abdominal pain on 12-APR-2021, was recovering from headache, and vomiting, and the outcome of protein in urine and blood in urine was not reported. This report was non-serious.


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