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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1380687



Case Details

VAERS ID: 1380687 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Texas  
Vaccinated:0000-00-00
Onset:2021-06-04
Submitted: 0000-00-00
Entered: 2021-06-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Hypoaesthesia oral, Nausea, Paraesthesia
SMQs:, Acute pancreatitis (broad), Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (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: Breast cancer (Diagnosed in 2019, in remission since 2020)
Preexisting Conditions: Comments: no known allergies
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210611869

Write-up: DIZZY; TINGLY ALL OVER BODY; LITTLE NUMBNESS IN TONGUE; NAUSEA; This spontaneous report received from a patient concerned a 40 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included in remission breast cancer, and other pre-existing medical conditions included no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A, and expiry: UNKNOWN) dose was not reported, administered on 03-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 04-JUN-2021, the subject experienced dizzy. On 04-JUN-2021, the subject experienced tingly all over body. On 04-JUN-2021, the subject experienced little numbness in tongue. On 04-JUN-2021, the subject experienced nausea. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from dizzy, tingly all over body, little numbness in tongue, and nausea. This report was non-serious.


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