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From the 11/12/2021 release of VAERS data:

This is VAERS ID 1696286

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Case Details

VAERS ID: 1696286 (history)  
Form: Version 2.0  
Age: 64.0  
Sex: Female  
Location: Florida  
   Days after vaccination:173
Submitted: 0000-00-00
Entered: 2021-09-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 - / IM

Administered by: Unknown       Purchased by: ?
Symptoms: COVID-19, Chest discomfort, Cough, Dyspnoea, Dyspnoea exertional, Fatigue, Pyrexia, Respiratory tract congestion, SARS-CoV-2 test positive
SMQs:, Anaphylactic reaction (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Cardiomyopathy (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (broad), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No significant past medical history
Allergies: Zithromax
Diagnostic Lab Data:
CDC Split Type:

Write-up: 9/13/21: Patient arrived at the ER due to worsening cough and shortness of breath. Per patient she returned from traveling on last Tuesday and since then experiencing worsening shortness of breath with exertion and dry cough. Associated with chest tightness and congestion and fatigue. The patient also reported recurring fevers. The patient was exposed to COVID-19 cases while traveling. The patient went to Clinic on Friday, COVID test was negative and the patient was started on doxycycline. Despite taking the medication her symptoms were getting worse therefore she decided to come to the ER. Patient tested positive for COVID on 9/13/21.

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