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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1350464

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Case Details

VAERS ID: 1350464 (history)  
Form: Version 2.0  
Age: 48.0  
Sex: Female  
Location: Georgia  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805031 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Bilevel positive airway pressure, Chest discomfort, Dyspnoea, Grunting, Wheezing
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Asthma/bronchospasm (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Eosinophilic pneumonia (broad), Hypersensitivity (broad), Respiratory failure (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: Anaphylaxis reaction to other vaccines
Other Medications: Maxide 75/50 daily, Potassium 20 meq daily, Lyrica 75mg daily
Current Illness: none
Preexisting Conditions: overweight, fibromyalgia, low potassium, dependent edema, history of tick fever
Allergies: NSAIDs, Latex, Imatrex, Relpax, insect stings, aspartame
Diagnostic Lab Data: unknown
CDC Split Type:

Write-up: 0905 tightening in chest, 0907 difficulty breathing-wheezing, grunting. Epi .3 mg x3 IM. Benadryl .25 po. 02 via nc at 3 LPM. EMS on arrival gave Predisone IM and 02 via face mask Pt was taken to the ER for treatment. Was started on BiPap overnight. Was discharged home the next day.

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