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

This is VAERS ID 1276586



Case Details

VAERS ID: 1276586 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Georgia  
Vaccinated:0000-00-00
Onset:2021-04-11
Submitted: 0000-00-00
Entered: 2021-05-01
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 1805025 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Headache, Pain in extremity, Ultrasound scan
SMQs:, Tendinopathies and ligament disorders (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
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: 202104; Test Name: Diagnostic ultrasound; Result Unstructured Data: no findings; Test Date: 202104; Test Name: Blood test; Result Unstructured Data: normal
CDC Split Type: USJNJFOC20210456315

Write-up: LEFT LEG PAIN; HEADACHES; This spontaneous report received from a parent concerned a 25 year old male. 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: 1805025, and expiry: UNKNOWN) dose was not reported, administered on 03-APR-2021 for prophylactic vaccination. No concomitant medications were reported. On APR-2021, Laboratory data included: Blood test (NR: not provided) normal, and Diagnostic ultrasound (NR: not provided) no findings. On 11-APR-2021, the subject experienced left leg pain. On 11-APR-2021, the subject experienced headaches. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from headaches, and left leg pain. This report was non-serious. This case, from the same reporter is linked to 20210456965.


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