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

This is VAERS ID 1453604



Case Details

VAERS ID: 1453604 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Connecticut  
Vaccinated:0000-00-00
Onset:2021-06-25
Submitted: 0000-00-00
Entered: 2021-07-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821281 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Fatigue, Herpes virus test, Injection site pain, Therapeutic response unexpected
SMQs:, Extravasation events (injections, infusions and implants) (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: Allergy; Bipolar disorder; Bone spur; Herpes infection; Migraine; Non-smoker
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data: Test Name: Herpes virus test; Result Unstructured Data: unknown
CDC Split Type: USJNJFOC20210708323

Write-up: GOING TO BATHROOM FINE SINCE VACCINATION, NO NEED OF TAKING LAXATIVE THAT WERE PRESCRIBED; PAIN IN THE LEFT ARM WHERE SHE HAD THE INJECTION; TIRED; This spontaneous report received from a patient concerned a 55 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included bipolar disorder, bone spurs, migraines, herpes types 1/2, quit smoking prior to vaccination, and grass mold mushrooms allergy.The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1821281, expiry: UNKNOWN) dose was not reported, administered on 25-JUN-2021 for prophylactic vaccination. No concomitant medications were reported. On 25-JUN-2021, the subject experienced going to bathroom fine since vaccination, no need of taking laxative that were prescribed. On 25-JUN-2021, the subject experienced pain in the left arm where she had the injection. On 25-JUN-2021, the subject experienced tired. Laboratory data (dates unspecified) included: Herpes virus test (NR: not provided) unknown. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from tired on 26-JUN-2021, and the outcome of pain in the left arm where she had the injection and going to bathroom fine since vaccination, no need of taking laxative that were prescribed was not reported. This report was non-serious.


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