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From the 5/14/2021 release of VAERS data (an older release, current is 7/16/2021):

This is VAERS ID 1267911



Case Details

VAERS ID: 1267911 (history)  
Form: Version 2.0  
Age: 61.0  
Sex: Female  
Location: California  
Vaccinated:2021-04-09
Onset:2021-04-21
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-04-28
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Chills, Cough, Fatigue, Nasopharyngitis, Pain, Pain in extremity, SARS-CoV-2 test negative
SMQs:, Anaphylactic reaction (broad), Tendinopathies and ligament disorders (broad), COVID-19 (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Pt called the call center. Reporting cold like symptoms"coughing, body aches, chills, both arms hurting, fatigue" after J&J covid vaccine 4/9/2021. Pt is taking ginger tea for symptoms but no medication. Pt denies emergency s/sx. Urgent Care appt made but pt no showed on4/21/21. New appt scheduled for 4/23/21. COVID test negative on 4/23/21.


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https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20210514&IDNUMBER=1267911


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