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

This is VAERS ID 1760011

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Case Details

VAERS ID: 1760011 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: Washington  
Vaccinated:2021-09-30
Onset:2021-09-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-04
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 211A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Blood pressure increased, Chest X-ray, Chest pain, Dyspnoea, Electrocardiogram, Hypersensitivity, Laboratory test, Oropharyngeal pain, Throat tightness
SMQs:, Anaphylactic reaction (broad), Angioedema (broad), Neuroleptic malignant syndrome (broad), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), Acute central respiratory depression (broad), Pulmonary hypertension (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

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? No
Previous Vaccinations:
Other Medications: L-thyroxine, Liothyronine, Naltrexone, Fluoxetine, Deplin, Trazodone, Glatiramer, Meloxicam, Amlodipine, Lisinopril, vit D, multivitamin, fish oil, probiotic, Zyflamend Whole Body (supplement)
Current Illness: none
Preexisting Conditions: Hashimoto''s Disease, hypertension, arthritis, psoriasis, endometriosis, MS
Allergies: sulfa, aspirin, Flexoril
Diagnostic Lab Data: EKG, chest xray, lab work, oxygen levels, signs of allergic reaction, blood pressure - all normal.
CDC Split Type:

Write-up: Over 4 hours, gradual tightness in throat followed by pain at base of throat and pain in center, upper chest. Asymmetric, high blood pressure in left and right arms over an hour. (220/? on right; 180/? on left) Throat tightness subsided but pain remained at base of throat and pain increased in center of chest and was followed by tightness of breath within 24 hours. Pain in chest and shortness of breath was identical to symptoms I experienced for 4 or 5 months following contracting COVID-19 in March, 2020. No fever. No signs of allergic reaction. Pain and shortness of breath lasted over 72 hours and began to improve in the 24 hours following that. Approx. 5 days of symptoms.


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