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From the 4/30/2021 release of VAERS data (an older release, current is 7/16/2021):

This is VAERS ID 1267898



Case Details

VAERS ID: 1267898 (history)  
Form: Version 2.0  
Age: 36.0  
Sex: Male  
Location: Arizona  
Vaccinated:2021-04-09
Onset:2021-04-11
   Days after vaccination:2
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / SYR

Administered by: Other       Purchased by: ?
Symptoms: COVID-19 pneumonia, Cough, Diarrhoea, Fatigue, Headache, Pyrexia, SARS-CoV-2 test positive, Vomiting
SMQs:, Anaphylactic reaction (broad), Acute pancreatitis (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Pseudomembranous colitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Noninfectious diarrhoea (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Infective pneumonia (narrow), Opportunistic infections (broad), COVID-19 (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 6 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Azmyhtrocine cefdinir dexamethasone asprini ec Siltussin Remdisivir treatment at hospital
Current Illness:
Preexisting Conditions: Asthma
Allergies:
Diagnostic Lab Data: covid pneumonia
CDC Split Type:

Write-up: hostpital for covid pneumonia three days later cough fatigue throwing up diahrea headache fever


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