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From the 7/23/2021 release of VAERS data:

This is VAERS ID 1301749



Case Details

VAERS ID: 1301749 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Oklahoma  
Vaccinated:0000-00-00
Onset:2021-05-02
Submitted: 0000-00-00
Entered: 2021-05-10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Arthralgia, Chills, Headache, Influenza, Pain, Palpitations, Spinal pain, Tremor, Vomiting
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Cardiomyopathy (broad), Arthritis (broad), Hypoglycaemia (broad), Infective pneumonia (broad), Opportunistic infections (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: Blood pressure high; Drug allergy
Preexisting Conditions: Comments: The patient was non alcoholic and non smoker. The patient did not have any drug abuse or illicit drug usage.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210506526

Write-up: PAIN IN SPINE; BODY SORENESS; JOINT PAIN; FLU; VOMITING; CHILLS; SHAKING; HEADACHE; HEART RACING; This spontaneous report received from a patient concerned a 53 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included high blood pressure, and compazine - napazine codeine allergy, and other pre-existing medical conditions included the patient was non alcoholic and non smoker. the patient did not have any drug abuse or illicit drug usage.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 206A21A, and batch number: 206A21A expiry: UNKNOWN) dose was not reported, administered on 02-MAY-2021 for prophylactic vaccination. No concomitant medications were reported. On 02-MAY-2021, the subject experienced heart racing. On 02-MAY-2021, the subject experienced body soreness. On 02-MAY-2021, the subject experienced joint pain. On 02-MAY-2021, the subject experienced flu. On 02-MAY-2021, the subject experienced vomiting. On 02-MAY-2021, the subject experienced chills. On 02-MAY-2021, the subject experienced shaking. On 02-MAY-2021, the subject experienced headache. On 04-MAY-2021, the subject experienced pain in spine. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from heart racing, vomiting, and chills on 04-MAY-2021, and shaking, and had not recovered from body soreness, joint pain, headache, pain in spine, and flu. This report was non-serious.


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