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

This is VAERS ID 1787787

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Case Details

VAERS ID: 1787787 (history)  
Form: Version 2.0  
Age: 55.0  
Sex: Female  
Location: Florida  
Vaccinated:2021-09-14
Onset:2021-09-14
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-10-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 LA / -

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood test, Chest X-ray, Computerised tomogram head, Epistaxis, Headache, Hypertension
SMQs:, Haemorrhage terms (excl laboratory terms) (narrow), Neuroleptic malignant syndrome (broad), Hypertension (narrow)

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: Zero
Current Illness: Zero
Preexisting Conditions: Thalassemia Minor
Allergies: Small pox vax Penicillin Morphine
Diagnostic Lab Data: Blood work x2 have Toradol , no other test or blood work and sent me home. States , ?not allowed to file VEARS for Covid vaccine per Hospital policy?. 9/15/21 , IV fluids, Ibuprofen, blood work and sent home. Same comment,?Not allowed to report to VEARS per policy.? 10/07/2021 Blood work, CT Brain, Chest X Rays. Fluid Iv, Toradol, Zinc Oxide, muscle relaxers, and anti inflammatory all via iv. Still have headaches, bp still high. Considered high normal.
CDC Split Type:

Write-up: High bp Severe headache Nose bleeds Started with in 20 minutes of vaccine. High bp and headaches continue since vax. daily issue


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