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From the 9/3/2021 release of VAERS data:

This is VAERS ID 1469607

Case Details

VAERS ID: 1469607 (history)  
Form: Version 2.0  
Sex: Male  
Location: Texas  
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1821281 / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Bronchitis, Chest pain, Chills, Dizziness, Hot flush, Neuralgia
SMQs:, Peripheral neuropathy (narrow), Anticholinergic 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:
Current Illness: Alcohol use (May be 2-3 drink at dinner, a couples of times per month.); Coronary artery disease; Marijuana abuse; Myocardial bridging; Smoker (About 1 pack per day. Trying to cut back.); Variant angina; Vasospasm
Preexisting Conditions: Medical History/Concurrent Conditions: Electrocardiogram (Blockage, but no infarction.); Hospitalisation; Comments: The patient had no known drug allergies.
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210708459

Write-up: BRONCHITIS AND DIFFICULTY BREATHING; SHARP BURNING PAIN IN CHEST; DIZZINESS; HOT FLASHES; NERVE PAIN IN LEGS; CHILLS; This spontaneous report received from a patient concerned a 54 year old male. The patient''s height, and weight were not reported. The patient''s past medical history included hospitalized, and electrocardiogram, and concurrent conditions included prinzmetal variant angina, myocardial bridge, non-obstructive coronary disease, vasospasm, alcohol user, smoker, and marijuana abuse, and other pre-existing medical conditions included the patient had no known drug allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 1821281 and expiry: UNKNOWN) dose was not reported, administered on 02-JUL-2021 12:00 for prophylactic vaccination. Concomitant medications included acetylsalicylic acid, amlodipine, atorvastatin, clonidine, glyceryl trinitrate, and metoprolol tartrate. On 03-JUL-2021, the subject experienced bronchitis and difficulty breathing. On 03-JUL-2021, the subject experienced sharp burning pain in chest. On 03-JUL-2021, the subject experienced dizziness. On 03-JUL-2021, the subject experienced hot flashes. On 03-JUL-2021, the subject experienced nerve pain in legs. On 03-JUL-2021, the subject experienced chills. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from nerve pain in legs on 03-JUL-2021, was recovering from chills, and hot flashes, and had not recovered from bronchitis and difficulty breathing, sharp burning pain in chest, and dizziness. This report was non-serious.; Sender''s Comments: V0: Medical assessment comment not required as per standard procedure as case was assessed as non-serious.

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