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

This is VAERS ID 1250807



Case Details

VAERS ID: 1250807 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Virginia  
Vaccinated:2021-04-08
Onset:2021-04-19
   Days after vaccination:11
Submitted: 0000-00-00
Entered: 2021-04-24
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Aspartate aminotransferase normal, Computerised tomogram head, Computerised tomogram normal, Dehydration, Differential white blood cell count, Dizziness, Electrocardiogram normal, Erythrocyte osmotic fragility test, Feeling cold, Full blood count, Headache, Lipase normal, Metabolic function test, Nausea, SARS-CoV-2 test negative, Urine analysis normal, Venogram normal, Vomiting
SMQs:, Acute pancreatitis (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (broad), Dehydration (narrow), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Fosomax
Current Illness: None
Preexisting Conditions: Bladder cancer survivor; osteoporosis
Allergies: Sulpha
Diagnostic Lab Data: 4/22/21: CBC and differential - normal Covid 19 raid - normal Comp metabolic panel - normal Got - normal Hemolysis index- normal Lipase - normal UA reflex to micro - normal CT head w/o contrast - normal CT venogram head - normal ECG 12 lead - normal
CDC Split Type:

Write-up: Extreme vomiting leading to dehydration requiring 3 L of IV saline; headache; nausea; chills; woozy feeling; all beginning 11 days after shot, leading to ER visit 14 days after shot. Still ill 15 days after shot but now have meds for symptoms.


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