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From the 5/7/2021 release of VAERS data (an older release, current is 7/16/2021):

This is VAERS ID 1231786



Case Details

VAERS ID: 1231786 (history)  
Form: Version 2.0  
Age:   
Sex: Female  
Location: Indiana  
Vaccinated:0000-00-00
Onset:2021-04-11
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 207A21A / UNK - / -

Administered by: Other       Purchased by: ?
Symptoms: Dizziness, Injection site pain
SMQs:, Anticholinergic syndrome (broad), Extravasation events (injections, infusions and implants) (broad), Vestibular disorders (broad)

Life Threatening? No
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: AMLODIPINE; LOSARTAN; HYDROCHLOROTHIAZIDE; PREDNISONE
Current Illness: Sinus infection
Preexisting Conditions: Comments: Unknown
Allergies:
Diagnostic Lab Data:
CDC Split Type: USJNJFOC20210429254

Write-up: DIZZY; ARM A LITTLE SORE; This spontaneous report received from a patient concerned a 56 year old female. The patient''s height, and weight were not reported. The patient''s concurrent conditions included sinus infection. The patient received covid-19 vaccine ad26.cov2.s (suspension for injection, route of admin not reported, batch number: 207A21A, and expiry: 23-JUN-2021) dose was not reported, administered on 11-APR-2021 for prophylactic vaccination. Concomitant medications included amlodipine for blood pressure, hydrochlorothiazide for blood pressure, losartan for blood pressure, and prednisone for sinus infection. On 11-APR-2021, the subject experienced arm a little sore. On 14-APR-2021, the subject experienced dizzy. The action taken with covid-19 vaccine ad26.cov2.s was not applicable. The patient had not recovered from dizzy, and arm a little sore. This report was non-serious.


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