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

This is VAERS ID 1262677



Case Details

VAERS ID: 1262677 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: New York  
Vaccinated:2021-04-08
Onset:2021-04-11
   Days after vaccination:3
Submitted: 0000-00-00
Entered: 2021-04-27
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / 1 - / IM

Administered by: Private       Purchased by: ?
Symptoms: Pain, Pyrexia, Rash, Sinus congestion, Upper-airway cough syndrome
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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? Yes, 5 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Dexlansoprazole and spironolactone
Current Illness:
Preexisting Conditions: GERD, hypertension
Allergies: Sulfa - rash. Penicillins -unknown reaction
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had a fever of 101 status post vaccine with body aches, rash to the left chest, sinus congestion and post-nasal drip. Symptoms started about 3 days after vaccine administration. Patient is currently inpatient


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