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From the 11/26/2021 release of VAERS data:

This is VAERS ID 1695332

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Case Details

VAERS ID: 1695332 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Unknown  
Location: Illinois  
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Other       Purchased by: ?
Symptoms: Asthenia, Body temperature, Chills, Fatigue, Injection site reaction, Nausea, Pain, Pyrexia
SMQs:, Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Guillain-Barre syndrome (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: OMEPRAZOLE
Current Illness: Irritable bowel syndrome (Patient is on Omeprazole.); Non-smoker; Social alcohol drinker (Patient consume alcohol sometimes but not today or yesterday.)
Preexisting Conditions: Medical History/Concurrent Conditions: Hernia; Comments: Patient have no known allergies.
Diagnostic Lab Data: Test Date: 20210910; Test Name: Body temperature; Result Unstructured Data: 101 F
CDC Split Type: USJNJFOC20210921355

Write-up: BODY ACHE; INJECTION SITE LITTLE HARD (ON RIGHT ARM); CHILLS; NAUSEA; 101 F FEVER; FATIGUE; NO ENERGY; This spontaneous report received from a patient concerned a 36 year old of unspecified sex. The patient''s height, and weight were not reported. The patient''s past medical history included: hernia, and concurrent conditions included: irritable bowel syndrome, alcohol user, and non smoker, and other pre-existing medical conditions included: Patient have no known allergies. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 207A20A, expiry: UNKNOWN) dose was not reported, administered on 10-SEP-2021 for prophylactic vaccination. Concomitant medications included omeprazole for irritable bowel syndrome. On 10-SEP-2021, the patient experienced body ache. On 10-SEP-2021, the patient experienced injection site little hard (on right arm). On 10-SEP-2021, the patient experienced chills. On 10-SEP-2021, the patient experienced nausea. On 10-SEP-2021, the patient experienced 101 f fever. On 10-SEP-2021, the patient experienced fatigue. On 10-SEP-2021, the patient experienced no energy. Laboratory data included: Body temperature (NR: not provided) 101 F. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from body ache, nausea, 101 f fever, chills, fatigue, no energy, and injection site little hard (on right arm). This report was non-serious.

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