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

This is VAERS ID 1481061



Case Details

VAERS ID: 1481061 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:0000-00-00
Onset:2021-07-03
Submitted: 0000-00-00
Entered: 2021-07-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207821A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Body temperature decreased, Headache, Heart rate, Heart rate abnormal, Nausea, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (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: Test Date: 20210703; Test Name: Body temperature; Result Unstructured Data: 101 F; Test Date: 20210703; Test Name: Pulse rate; Result Unstructured Data: not reported; Test Date: 20210703; Test Name: Body temperature decrease; Result Unstructured Data: 97.1 F
CDC Split Type: USJNJFOC20210708993

Write-up: PULSE RATE; HEADACHE(COMING AND GOING); NAUSEA; FEVER; This spontaneous report received from a patient concerned a 67 year old male. 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: 207821A, expiry: UNKNOWN) dose was not reported, administered on 03-JUL-2021 09:30 for prophylactic vaccination. No concomitant medications were reported. On 03-JUL-2021, the subject experienced pulse rate. On 03-JUL-2021, the subject experienced headache (coming and going). On 03-JUL-2021, the subject experienced nausea. On 03-JUL-2021, the subject experienced fever. Laboratory data included: Body temperature (NR: not provided) 101 F, Body temperature decrease (NR: not provided) 97.1 F, and Pulse rate (NR: not provided) not reported. Treatment medications (dates unspecified) included: paracetamol. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient recovered from fever on 03-JUL-2021, had not recovered from headache(coming and going), and the outcome of nausea and pulse rate was not reported. This report was non-serious.


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