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

This is VAERS ID 1431981



Case Details

VAERS ID: 1431981 (history)  
Form: Version 2.0  
Age: 59.0  
Sex: Female  
Location: Ohio  
Vaccinated:2021-06-26
Onset:2021-06-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / 1 AR / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Angiogram, Aphasia, Balance disorder, Computerised tomogram head normal, Computerised tomogram neck, Confusional state, Dizziness, Feeling abnormal, Intracranial aneurysm, Laboratory test, Surgery
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (narrow), Vestibular disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: trazodone, pregabalin, potassium chloride, lidocaine ointment, lamotrigine, furosemide, folic acid, eszopiclone, clopidogrel, clonazepam, Breo Ellipta, baclofen, atorvastatin, aspirin, aripiprazole, albuterol inhaler
Current Illness:
Preexisting Conditions: COPD, obesity, type 2 diabetes, left internal carotid artery aneurysm with stenting, obstructive sleep apnea, coronary artery disease, bipolar depression, hepatitis C, hyperlipidemia, gastroparesis, restless leg syndrome, dysarthria, urinary incontinence, GERD, history of CVA, migraine
Allergies: beta blockers, ACEIs, diphenhydramine, cyclobenzaprine, adhesive tape
Diagnostic Lab Data: 6/28/21 CT head and neck (non-contrast) - no acute abnormality CTA head and neck - no large vessel occlusion other labs WNL
CDC Split Type:

Write-up: Patient reports that for the past two days (since date of vaccination) she has felt dizzy. She also reports ongoing confusion since her surgery for her cerebral aneurysm. She reports that for the past few days she has been bumping into walls and generally feeling off balance as well as experiencing word-finding difficulties. Patient is being admitted for MRI and neurology evaluation. CT and CTA of the head show no acute abnormalities.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1431981


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