National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

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

This is VAERS ID 1084126



Case Details

VAERS ID: 1084126 (history)  
Form: Version 2.0  
Age: 50.0  
Sex: Female  
Location: Indiana  
Vaccinated:2021-03-07
Onset:2021-03-07
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN - / 1 RA / UN

Administered by: Other       Purchased by: ?
Symptoms: Eye swelling, Immediate post-injection reaction, Pharyngeal swelling, Rash, Swollen tongue
SMQs:, Anaphylactic reaction (narrow), Angioedema (narrow), Oropharyngeal allergic conditions (narrow), Oropharyngeal conditions (excl neoplasms, infections and allergies) (narrow), 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? Yes, 2 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Magnesium supplement 400mg Lisinopril 10mg Enoxaparin Sodium 40mg Aspirin
Current Illness: Transient ischemic attack Hypertension Antiphospholipid antibody syndrome Migraine variant
Preexisting Conditions: Transient ischemic attack Hypertension Antiphospholipid antibody syndrome Migraine variant
Allergies: Compazine Doxycycline Nuts Lipitor Almovig Banana
Diagnostic Lab Data:
CDC Split Type:

Write-up: Immediate rash in chest and face. 20 minutes later entered ER with swollen eye and throat. 14 hours later re-entered ER with rash on chest and face, swollen tongue and throat


New Search

Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1084126


Copyright © 2021 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166