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

This is VAERS ID 1276415

Case Details

VAERS ID: 1276415 (history)  
Form: Version 2.0  
Age: 32.0  
Sex: Female  
Location: Florida  
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808978 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Cough, Diarrhoea, Dizziness, Dyspnoea, Malaise, Multiple allergies, Nausea, Neck pain, Vision blurred
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Cardiomyopathy (broad), Lens disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypersensitivity (narrow), Arthritis (broad), Noninfectious diarrhoea (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: Comments: she had no history of allergies.
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210444480

Write-up: TROUBLE BREATHING; NECK PAIN; BLURRY VISION; DIARRHEA; DIZZINESS; COUGH; FEEL SICK; WEAKNESS; NAUSEA; ALLERGIES; This spontaneous report received from a patient concerned a 32 year old female. The patient''s height, and weight were not reported. The patient''s pre-existing medical conditions included she had no history of allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1808978, expiry: 13/JUN/2021) dose was not reported, administered on 11-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On 11-APR-2021, the subject experienced allergies. On 11-APR-2021, the subject experienced cough. On 11-APR-2021, the subject experienced feel sick. On 11-APR-2021, the subject experienced weakness. On 11-APR-2021, the subject experienced nausea. On 13-APR-2021, the subject experienced diarrhea. On 13-APR-2021, the subject experienced dizziness. On 15-APR-2021, the subject experienced neck pain. On 15-APR-2021, the subject experienced blurry vision. On 17-APR-2021, the subject experienced trouble breathing. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from weakness, dizziness, neck pain, blurry vision, trouble breathing, cough, allergies, nausea, diarrhea, and feel sick. This report was non-serious.; Sender''s Comments: V0: Medical Assessment comment not required as per standard procedure as the case assessed as non-serious.

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