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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1075575



Case Details

VAERS ID: 1075575 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Mississippi  
Vaccinated:2021-03-04
Onset:2021-03-04
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805020 / 1 LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Blood pressure increased, Palpitations, Swelling face
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Neuroleptic malignant syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Hypertension (narrow), Cardiomyopathy (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Xyzal 5 mg po daily
Current Illness:
Preexisting Conditions: seasonal allergies, BMI $g/= 30
Allergies: Sulfa (purple rash)
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: 14:59 - RN responded to waiting lot. Pt c/o sensation of facial swelling and heart racing. Denied other complaints. At 1500 BP 110/80, HR 140, R 12. 1503: Pt helt HR slowing down. No further feeling of swelling in face, throat, or elsewhere. 1505: HR 128. 1510: Pt talking, breathing without difficulty. Advised to seek medical attention if s/sx worsen. 3/5/21 @ 1040: Another RN followed up with ph call. Pt reported that after leaving site, she felt HR beginning to speed up. Went to ED and was monitored x 2 hrs. Systolic pressure there was 161. HR was in 140''s. No interventions. After 2 hrs VS stabilized and pt was discharged home. Is fine today.


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