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

This is VAERS ID 1463036



Case Details

VAERS ID: 1463036 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: New Jersey  
Vaccinated:0000-00-00
Onset:2021-07-02
Submitted: 0000-00-00
Entered: 2021-07-11
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Headache, Lethargy, Pain in extremity
SMQs:, Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Tendinopathies and ligament 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? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210718975

Write-up: LETHARGY; PAIN IN ARM; HEADACHE; This spontaneous report received from a patient concerned a 53 year old female. The patient''s height, and weight were not reported. No past medical history or concurrent conditions were reported.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 02-JUL-2021 18:30 for prophylactic vaccination. No concomitant medications were reported. On 02-JUL-2021, the subject experienced pain in arm. On 02-JUL-2021, the subject experienced headache. On 03-JUL-2021, the subject experienced lethargy. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient was recovering from headache, lethargy, and pain in arm. This report was non-serious. This case, from the same reporter is linked to 20210710122.


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