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

This is VAERS ID 1260021

Case Details

VAERS ID: 1260021 (history)  
Form: Version 2.0  
Age: 46.0  
Sex: Female  
Location: Ohio  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808982 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Abdominal pain, Blood gases, Cardiac monitoring, Chest pain, Chills, Computerised tomogram thorax, Differential white blood cell count, Dyspnoea, Electrocardiogram, Fatigue, Feeling of body temperature change, Full blood count, Headache, Metabolic function test, Pregnancy test urine, Urine analysis
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Retroperitoneal fibrosis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: One A Day Women''s complete Multivitamin/ Estradiol 0.5 mg tab/Goli Apple Cider Vimegar (2 gummies)
Current Illness: none
Preexisting Conditions: Irritable bowel syndrome/acid reflux
Allergies: Penicillin/ Adhesive Tape/Egg/Pistachio Nut/Lactose intolerance
Diagnostic Lab Data: Basic metabolic panel/chemical urialysis/complete blood count with differential/urine pregnancy screen/venous blood gas/ct chest pe protocol/ekg standard/cardiac monitor/oxygen/saline lock insert/ iohexol (omnipaque) /prednisone/saline flush/nacl 0.9%
CDC Split Type:

Write-up: Got Johnson and Johnson shot 4/10/2021: 4/11/21-4/12/21 headache, hot and cold chills 4/13/21- abdominal pain and shortness of breath 4/14/21- shortness of breath (sob) 4/15/21- headache, pain right side chest 4/16/21- fatigue, pain left side chest 4/17/21- sob (bad) 4/18/21- 4/21/21 sob 4/22/21 -woke up struggling to breath. Family Physician sent me to hospital. She was thinking blood clot lungs 4/23/21-current sob

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