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

This is VAERS ID 1429297

Case Details

VAERS ID: 1429297 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: New York  
Submitted: 0000-00-00
Entered: 2021-06-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Military       Purchased by: ?
Symptoms: Back pain, Chills, Fatigue, Headache, Limb discomfort, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Retroperitoneal fibrosis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Abstains from alcohol; Non-smoker; Penicillin allergy
Preexisting Conditions: Medical History/Concurrent Conditions: Hemorrhagic ulcer (about 3-4 years ago but it has since resolved and she currently has no medical conditions and takes no medications); Comments: The patient had no history of drug abuse or illicit drug use.
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210647120

Write-up: HEAVY FEELING IN BOTH LEGS, HEAVINESS HARDER IN RIGHT LEG; TIREDNESS; FEVER; HEADACHE; NAUSEA; CHILLS; BACK PAIN; PAIN IN BODY; This spontaneous report received from a patient concerned a 57 year old female. The patient''s height, and weight were not reported. The patient''s past medical history included bleeding ulcer, and concurrent conditions included non-alcohol user, non-smoker, and penicillin allergy, and other pre-existing medical conditions included the patient had no history of drug abuse or illicit drug use. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A expiry: 07-AUG-2021) dose was not reported, administered on 20-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 20-JUN-2021, the subject experienced back pain. On 20-JUN-2021, the subject experienced pain in body. On 20-JUN-2021, the subject experienced chills. On 20-JUN-2021, the subject experienced fever. On 20-JUN-2021, the subject experienced headache. On 20-JUN-2021, the subject experienced nausea. Treatment medications included: paracetamol. On 21-JUN-2021, the subject experienced tiredness. On 22-JUN-2021, the subject experienced heavy feeling in both legs, heaviness harder in right leg. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from chills, fever, and nausea on 21-JUN-2021, and headache on 22-JUN-2021, had not recovered from heavy feeling in both legs, heaviness harder in right leg, and the outcome of pain in body, tiredness and back pain was not reported. This report was non-serious.

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