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

This is VAERS ID 1442780



Case Details

VAERS ID: 1442780 (history)  
Form: Version 2.0  
Age: 37.0  
Sex: Male  
Location: Unknown  
Vaccinated:0000-00-00
Onset:2021-06-25
Submitted: 0000-00-00
Entered: 2021-07-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 203A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Chest pain, Dizziness, Pain, Taste disorder
SMQs:, Taste and smell disorders (narrow), Anticholinergic syndrome (broad), Guillain-Barre syndrome (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Cardiomyopathy (broad), 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: Blood pressure high (The patient takes a water pill and two other medication.); Gout (The patient takes medication for gout).
Preexisting Conditions: Comments: The patient had no known allergies.
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210666592

Write-up: FELT TASTE OF BLOOD IN MOUTH; FELT SORENESS; FEELING OF PAIN IN CHEST; NO ENERGY; DIZZINESS; This spontaneous report received from a consumer concerned a 37 year old male. The patient''s height, and weight were not reported. The patient''s concurrent conditions included high blood pressure, and gout, and other pre-existing medical conditions included the patient had no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 203A21A, expiry: UNKNOWN) dose was not reported, administered on 23-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 25-JUN-2021, the subject experienced dizziness. On 25-JUN-2021, the subject experienced no energy. On 26-JUN-2021, treatment medications included: paracetamol. On 27-JUN-2021, the subject experienced felt soreness. On 27-JUN-2021, the subject experienced feeling of pain in chest. On 29-JUN-2021, the subject experienced felt taste of blood in mouth. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from dizziness, and no energy, and the outcome of felt soreness, feeling of pain in chest and felt taste of blood in mouth was not reported. This report was non-serious.


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