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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1700945

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Case Details

VAERS ID: 1700945 (history)  
Form: Version 2.0  
Age: 34.0  
Sex: Female  
Location: New York  
Vaccinated:2021-08-06
Onset:2021-09-10
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Appendicitis, Computerised tomogram abdomen abnormal
SMQs:, Retroperitoneal fibrosis (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Keppra XR, Seasonique, Vitamin D, Vitamin B 12, Magnesium, Elderberry sambuccus,
Current Illness: None
Preexisting Conditions: Seizure disorder, morbid obesity
Allergies: Penicillin
Diagnostic Lab Data: CT done in ER 9/10 confirming acute appendicitis
CDC Split Type:

Write-up: Developed acute appendicitis approx. 5 weeks after vaccine


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