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

This is VAERS ID 1701313

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Case Details

VAERS ID: 1701313 (history)  
Form: Version 2.0  
Age: 21.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-07-26
Onset:2021-08-30
   Days after vaccination:35
Submitted: 0000-00-00
Entered: 2021-09-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 202A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Abdominal pain upper, Appendicectomy, Appendicitis, Condition aggravated, Herpes zoster, Pain, Rash
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Opportunistic infections (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Multi vitamin, Zinc, Vitamin D
Current Illness: I had shingles and was taking medication for that I was on about day 4 of that medication.
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: We went to the hospital the evening of 8/30/2021 and was released 8/31/2021
CDC Split Type:

Write-up: About 3 weeks later she broke out with a painful bumps under my arm that felt like nothing she had experienced before. They wouldn''t go away she was diagnosed with shingles. Then about 4 days after starting the medication we were on vacation and she had a severe stomach ache. She was in a lot of pain I took her to the hospital where they diagnosed with the an Appendicitis, and needed it removed.


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