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

This is VAERS ID 1273648

Case Details

VAERS ID: 1273648 (history)  
Form: Version 2.0  
Age: 38.0  
Sex: Female  
Location: Montana  
   Days after vaccination:16
Submitted: 0000-00-00
Entered: 2021-04-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Chest X-ray, Chest pain, Fatigue, Fibrin D dimer, Headache, Lethargy, Pain, Pain in extremity, Paraesthesia, Rash, Thirst
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad), Dehydration (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: lisinopril 20mg -Htcz 12.5 mg once daily, Claritin, Vitamin D 10,000 BU a day, Cotreat Pro-biotic daily
Current Illness: Cold, in Mid- February
Preexisting Conditions: High Blood Pressure since Oct. 2019 started medication
Allergies: Medication allergy Pela Cillian, Almecillin, and Keflex
Diagnostic Lab Data: 04/16/2021 chest xray and blood work De diamer test
CDC Split Type:

Write-up: 03/26/2021 PM Slightly fatigue and lethargic, arm hurt and tingly and was thrusty after the vaccination after the vaccination, next day a head ache, and have aches and pains. 04/16/2021 chest ex De diamer test, primary care doctor Ultra sound of the gallbladder Stomach and nausish gallbladder and chest exray and blood work on 04/20/21 Rash developed Currently, still have the rash today 04/26/2021 ER Chest pain, Chest CT, De diamer, EKG

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