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

This is VAERS ID 1269931



Case Details

VAERS ID: 1269931 (history)  
Form: Version 2.0  
Age: 23.0  
Sex: Female  
Location: New Hampshire  
Vaccinated:0000-00-00
Onset:2021-04-11
Submitted: 0000-00-00
Entered: 2021-04-29
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Back pain, Chills, Genital rash, Haematochezia, Headache, Pain, Pyrexia
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal haemorrhage (narrow), Ischaemic colitis (broad), Hypersensitivity (broad), 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? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: patient had no known allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210432632

Write-up: BLOOD IN STOOL; RASH ON FANNY; CHILLS; FEVER; HEADACHE; BODY ACHES; BACK ACHE; This spontaneous report received from a parent concerned a 23 year old, white, and not Hispanic or Latino female. The patient''s height, and weight were not reported. The patient had no known allergies. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: Unknown) dose was not reported, one total, administered on 11-APR-2021 for prophylactic vaccination. The batch number was not reported and has been requested. No concomitant medications were reported. On 11-APR-2021, the patient had body aches, chills, fever, headache and backache (low back pain). On 12-APR-2021, Monday, she felt better but experienced backache again on 13-APR-2021, Tuesday and felt better later that day. On 14-APR-2021, at night she had weird rash on fanny and also had lower back pain. On 15-APR-2021 morning, she had blood in stool and again experienced backache (pain in the lower back). The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from body aches, chills, fever, and headache on 13-APR-2021, and had not recovered from back ache, rash on fanny, and blood in stool. This report was serious (Other Medically Important Condition).; Sender''s Comments: V0: 20210432632-Covid-19 vaccine ad26.cov2.s -Blood in stool. This event(s) is considered unassessable. The event(s) has a compatible/suggestive temporal relationship, is unlabeled, and has unknown scientific plausibility. There is no information on any other factors potentially associated with the event(s).


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