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

This is VAERS ID 1704175

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Case Details

VAERS ID: 1704175 (history)  
Form: Version 2.0  
Age: 52.0  
Sex: Female  
Location: Virginia  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-09-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 RA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood test, Bronchitis, Dyspnoea, Feeling abnormal, Hypersomnia, Immune system disorder, Impaired work ability, Loss of personal independence in daily activities, Skin lesion, Thyroid function test abnormal
SMQs:, Anaphylactic reaction (broad), Dementia (broad), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (broad), Hypothyroidism (broad), Hyperthyroidism (broad), Depression (excl suicide and self injury) (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Levothyroxine, Lisinopril
Current Illness: Diverticulitis - was being treated with antibiotics
Preexisting Conditions: High Blood Pressure, Thyroid taken out
Allergies: Raspberries
Diagnostic Lab Data: Blood work - thyroid levels are way off - August 5th 2021 Blood work - thyroid levels are way off - July 19 2021 Blood work - thyroid levels are way off - July 14 2021
CDC Split Type: vsafe

Write-up: Well in the middle of on the 13th I was diagnosed with Bronchitis. It went on all summer long and continues to this day. I am on inhalers, nebulizers and cannot walk thirty feet without being winded. I am out on long term disability now. My family has to help me get dressed and help me otherwise physically. I sleep about 17 hours a day. I got foggy brain really bad and my thyroid numbers have been really messed up from the shot. I was due for my 6 months check up and my endo DR cannot get my numbers to stabilize. I have hypothyroidism. Also my immune system is shot, I cannot leave my house now. I''ve also seen an ENT for lesions on the side of my tongue, that was on August 11 2021.

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