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From the 6/11/2021 release of VAERS data:

This is VAERS ID 1269147



Case Details

VAERS ID: 1269147 (history)  
Form: Version 2.0  
Age:   
Sex: Unknown  
Location: Minnesota  
Vaccinated:0000-00-00
Onset:2021-04-21
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN UNKNOWN / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 test, Suspected COVID-19
SMQs:, 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Date: 20210421; Test Name: COVID-19 antigen test; Result Unstructured Data: Positive; Test Date: 20210422; Test Name: COVID-19 antigen test; Result Unstructured Data: Positive
CDC Split Type: USJNJFOC20210446463

Write-up: SUSPECTED COVID-19 INFECTION; This spontaneous report received from a health care professional concerned a patient of unspecified age and sex. The patient''s weight, height, and medical history were not reported.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unk) dose was not reported, administered on 12-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 21-APR-2021, the subject experienced suspected covid-19 infection. Laboratory data included: COVID-19 antigen test (NR: not provided) Positive. On 22-APR-2021, Laboratory data included: COVID-19 antigen test (NR: not provided) Positive. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The outcome of suspected covid-19 infection was not reported. This report was non-serious.; Sender''s Comments: V0 Medical assessment comment not required as per standard procedure as the case was assessed as non-serious.


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