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

This is VAERS ID 1717694

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Case Details

VAERS ID: 1717694 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Foreign  
Vaccinated:0000-00-00
Onset:2021-09-04
Submitted: 0000-00-00
Entered: 2021-09-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Chills, Conjunctivitis, Erythema, Eye pruritus, Hypersensitivity, Lacrimation increased, Myalgia, Pruritus, Restless legs syndrome, Rhinitis allergic, Rhinorrhoea, Sneezing, Somnolence, Throat irritation
SMQs:, Rhabdomyolysis/myopathy (broad), Severe cutaneous adverse reactions (broad), Anaphylactic reaction (narrow), Angioedema (broad), Anticholinergic syndrome (broad), Dementia (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Eosinophilic pneumonia (broad), Conjunctival disorders (narrow), Lacrimal disorders (narrow), Ocular infections (broad), Hypersensitivity (narrow), Tendinopathies and ligament disorders (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

Life Threatening? Yes
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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210814; Test Name: Body temperature; Result Unstructured Data: 39.4 Cel
CDC Split Type: ROJNJFOC20210934431

Write-up: SLEEPINESS; ITCHING - GENERALISED; REDNESS GENERALISED; TEARING EYES; RHINOCONJUNCTIVITIS; ITCHING EYES; THROAT IRRITATION; MYALGIA; RESTLESS LEGS; CHILLS; ALLERGIC RHINITIS; SNEEZING; RHINORRHEA; REDNESS; HYPERSENSITIVITY REACTION; This spontaneous report received from a consumer via Regulatory Authority (RO-NMA-2021-SPCOV12536) on 17-SEP-2021 concerned a 34 year old female of unspecified race and ethnic origin. The patient''s weight was 65 kilograms, and height was 168 centimeters. No past medical history or concurrent conditions were reported. The patient received Covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: XE393 and expiry: unknown) 1 dosage forms, 1 total administered on 03-SEP-2021 for active immunisation. No concomitant medications were reported. On 14-AUG-2021, the patient had laboratory test of body temperature which was found to be 39.4 Cel. On 04-SEP-2021, the patient experienced rhinoconjunctivitis, had allergic rhinitis, rhinorrhea, sneezing, redness, had hypersensitivity reaction, chills, throat irritation, myalgia, tearing eyes, itching in eyes and had restless legs. On 05-SEP-2021, the patient experienced sleepiness, had generalized redness and generalized itching. The action taken with Covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from redness generalised, tearing eyes, rhinoconjunctivitis, sleepiness, allergic rhinitis, sneezing, rhinorrhea, redness, hypersensitivity reaction, itching - generalised, itching eyes, throat irritation, myalgia, restless legs, and chills. This report was serious (Other Medically Important Condition, and Life Threatening).


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