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

This is VAERS ID 1079425



Case Details

VAERS ID: 1079425 (history)  
Form: Version 2.0  
Age: 70.0  
Sex: Female  
Location: New Mexico  
Vaccinated:2021-03-06
Onset:2021-03-06
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-07
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / N/A LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Asthenia, Chest X-ray normal, Electrocardiogram normal, Flushing, Full blood count, Metabolic function test, Troponin I normal
SMQs:, Anaphylactic reaction (broad), Guillain-Barre syndrome (broad), Hypersensitivity (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: penicillin (puncture wound), anaphylactic shock, age 2, 1952
Other Medications: losartan, amlodipine, montelukast, atorvastatin, paroxetine, AREDS vitamins, Advair HFA 230/21 inhaler for asthma
Current Illness: none
Preexisting Conditions: Moderate asthma, fibromyalgia, primary hypertension, general anxiety disorder
Allergies: Penicillin (anaphylactic shock at age 2) Oxaprozin (NSAID) -- face turned bright red - early 50s Sulfa drugs -- hives - mid-50s
Diagnostic Lab Data: 3/6/2021 EKG - normal chest X-ray - normal triponin 1 - normal CBC and comprehensive metabolic panel - normal
CDC Split Type:

Write-up: I received the vaccine at a Department of Health vaccine clinic at the Hospital. About 25 minutes after receiving the Janssen vaccine, my face became flushed (red) and I felt weak. We were in the hospital parking lot and drove to that hospital''s emergency room, where I was evaluated. After several tests (item 18) I was declared okay and left after 3 hours with no further intervention. I probably should have taken a Benadryl (diphenhydramine) after the shot to prevent such a reaction.


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