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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1373256



Case Details

VAERS ID: 1373256 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: California  
Vaccinated:0000-00-00
Onset:2021-06-01
Submitted: 0000-00-00
Entered: 2021-06-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache, Nausea, Pain
SMQs:, Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow)

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:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210604689

Write-up: FEELS ACHES AND PAINS; FEELING SICK TO STOMACH; FEELS LIKE GETTING A HEADACHE; This spontaneous report received from a patient concerned a female of unspecified age. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported.The patient received covid-19 vaccine (suspension for injection, route of admin not reported, batch number: 201A21A, expiry: UNKNOWN) dose was not reported, administered on 01-JUN-2021 19:00 for prophylactic vaccination. No concomitant medications were reported. On 01-JUN-2021, the subject experienced feels aches and pains. On 01-JUN-2021, the subject experienced feeling sick to stomach. On 01-JUN-2021, the subject experienced feels like getting a headache. The action taken with covid-19 vaccine was not applicable. The patient had not recovered from feeling sick to stomach, feels aches and pains, and feels like getting a headache. This report was non-serious.


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