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From the 1/14/2022 release of VAERS data:

This is VAERS ID 1212596

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Case Details

VAERS ID: 1212596 (history)  
Form: Version 2.0  
Age: 74.0  
Sex: Female  
Location: Missouri  
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805018 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blood lactic acid normal, Confusional state, Discomfort, Endotracheal intubation, Feeling abnormal, Intensive care, N-terminal prohormone brain natriuretic peptide increased, Sepsis, Troponin T increased, Unresponsive to stimuli
SMQs:, Cardiac failure (broad), Angioedema (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Myocardial infarction (narrow), Anticholinergic syndrome (broad), Dementia (broad), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (broad), Hypoglycaemia (broad), Sepsis (narrow), Opportunistic infections (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? Yes, 7 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Spironolactone Duloxetine Insulin Lactulose Nadolol Rifaximin SITagliptin Bumetanide Omeprazole Cyanocobalamin cholecalciferol
Current Illness: None
Preexisting Conditions: Cirrhosis Diabetes, Type 2
Allergies: Aspirin, Beta Blockers, Statins
Diagnostic Lab Data: SEPSIS LACTATE WITH REFLEX result 4.5 PRO B-TYPE NATRIURETIC PEPTIDE result 1984 Troponin T high-sensitivity result 93
CDC Split Type:

Write-up: Patient woke up at 3am not feeling good and confused. Became increasingly confused and uncomfortable. Not very responsive to caregivers. Called an ambulance at 7:30am. ER ran tests that showed Sepsis with n o underlying infection. Patient had to be intubated. Admitted to ICU in hospital. Spent 3 days there and 4 days in regular room at hospital. Then transferred to a rehabilitation clinic where she is currently.

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