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

This is VAERS ID 1266358

Case Details

VAERS ID: 1266358 (history)  
Form: Version 2.0  
Age: 80.0  
Sex: Female  
Location: Michigan  
   Days after vaccination:31
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1802072 / 1 - / SYR

Administered by: Unknown       Purchased by: ?
Symptoms: Asthenia, COVID-19, Cough, Decreased appetite, Dyspnoea, Illness, Oesophageal motility disorder, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

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: Bumex, albuterol, Pulmicort, carvedilol, Cardizem, Lexapro, Vytorin, flucticasone-umeclidin-vilant, formoterol fumarate, Norco, insulin, levothyroxine, omeprazole, ramipril, spironolactone
Current Illness:
Preexisting Conditions: Arthritis, asthma, B12 deficiency, cardiomyopathy, chronic lumbar pain, COPD, depression, dyslipidemia, GERD, hiatal hernia, history of thyroid cancer, hypertension, hypothyroidism, incontinence, obesity, on home O2, psoriasis, thyroid disease, venous insufficiency
Allergies: Sulfa antibiotics
Diagnostic Lab Data: SARS-CoV-2 (COVID-19) and Influenza AB Antigens, POC: Positive (4/23/2021)
CDC Split Type:

Write-up: 80y.o. female with past medical history of COPD on 3L O2 at home, Asthma, Arthritis, B12 deficiency, Depression, GERD, Achalasia, HTN and Hypothyroidism presented with a chief complaint of cough and weakness. Patient states that she had the Johnson & Johnson vaccine on March 11th 2021 and believes she got sick from it. Since getting the vaccine, whenever she eats something she begins vomiting for the next 2 days. This has happened to the patient before, as she has a history of esophageal dysmotility/achalasia. Patient began developing a cough and SOB over the last 2 weeks that are getting worse. Patient states that she has no appetite at all and is feeling very weak due to the lack of eating.

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